Conservative management of cervical pregnancy with subsequent fertility

Article Abstract:

An ectopic pregnancy occurs when the embryo implants outside of the uterus. Implantation of the fetus in the canal of the cervix (the neck of the uterus) is rare. Painless bleeding accompanies cervical implantation. Diagnosis is confirmed by ultrasonography, the use of high frequency sound to visualize internal structures. This potentially life-threatening condition usually requires removal of the entire uterus. A 41-year-old woman, seven weeks pregnant, reported painless bleeding which lasted two weeks. She had lost a previous pregnancy at 30 weeks from a complication involving a Dalkon shield intrauterine device (IUD). This was followed by three years of infertility. Ultrasonography indicated an enlarged cervix and a cervical pregnancy was diagnosed. The products of conception were removed, causing severe hemorrhage. In an effort to retain the uterus for future pregnancy, a balloon was inserted to apply pressure and control the bleeding. This was followed by a cervical cerclage, the suturing of the narrow end of the cervical opening. The use of this conservative treatment was effective in controlling the hemorrhage and preserving the reproductive potential. The patient conceived nine months later and delivered a normal healthy infant at 37 weeks of pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Uterine bleeding, Uterine hemorrhage

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Successful treatment of a viable cervical pregnancy with methotrexate

Article Abstract:

In a normal pregnancy when fertilization of an egg occurs, the embryo implants in the uterus. An implantation anywhere outside of the uterus is considered an ectopic pregnancy and must be removed. Embryos implanting on the cervix is extremely rare. Hemorrhage of the blood vessels in the cervix can be severe, and cause maternal death. To prevent death from hemorrhage the entire uterus is removed with the fetus. Methotrexate, a chemotherapeutic drug which causes cell death, was injected into a nine-week-old fetus implanted on the cervix of a 35-year-old woman. Bleeding from the vagina resolved and the fetal heartbeat stopped. The remaining tissue was removed and the patient returned home with an intact uterus. Methotrexate was a practical alternative for the treatment of a potentially life-threatening ectopic pregnancy.

Alternative medicine

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Isthmic ectopic gestation: a contraindication to methotrexate therapy?

Article Abstract:

Ectopic pregnancy with invasion into the tubal isthmus may be a contraindication to methotrexate therapy. A 27-year-old woman with a history of pelvic inflammatory disease and a ruptured right ectopic pregnancy had another ectopic pregnancy in the left tube. She chose methotrexate therapy because she wanted to preserve fertility on the left side. On the 12th day of methotrexate treatment, she was hospitalized with abdominal pain and low blood pressure. Surgery revealed another ruptured tubal pregnancy. The woman met all the criteria for methotrexate therapy of ectopic pregnancy, but the tube still ruptured.

Complications and side effects

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