NON TUBAL ECTOPIC PREGNANCY: A QUICK REVIEW OF CERVICAL PREGNANCY AND ITS MANAGEMENT

CONTENT

-INTRODUCTION

-RISK FACTORS

-PRESENTATION

-INVESTIGATIONS

-MANAGEMENT

 

INTRODUCTION

Cervical pregnancies are rare and found in less than 1% of all ectopic gestations, with an estimated incidence of one in 2500 to one in 18,000 pregnancies.

                                                 cervical pregnancy

 

RISK FACTORS

Perhaps the commonest risk factor for cervical pregnancy is a history of dilation and curettage (D&C) in a previous pregnancy which is found in nearly 70 % of cases. Other possible risk factors are structural abnormalities such as uterine fibroids, uterine synechiae and abnormalities caused by diethylstilbestrol (DES) exposure of a femal fetus while within her mother’s womb. Intrauterine devices (IUD) and IVF have also been implicated.

 

PRESENTATION

Cervical ectopic pregnancies often present with painless vaginal bleeding after a long period of absence of menses. In advanced cases, in addition to profuse vaginal bleeding, there may be associated abdominal pain and urinary problems.

 

INVESTIGATIONS

Aside a detailed history, a thorough clinical examination and a positive blood pregnancy test, the definitive diagnosis is usually by a transvaginal ultrasound scan. Other investigations including blood works are similar to those done for tubal ectopic pregnancy

 

MANAGEMENT

The management of cervical pregnancies may be medical or surgical, with many centers utilizing a combination of the two.

MEDICAL TREATMENT

This involves the use of single or multiple doses of cytotoxic drugs. Local injection of similar drugs or feticide into the ectopic pregnancy can also be done under ultrasound guidance.

SURGICAL TREATMENT

Dilation and curettage (D&C); although a first line treatment, it is seldom used alone, given the risk of bleeding that may require hysterectomy in up to about 40 % of cases. Methods for decreasing the risk of bleeding prior to D & C, include the injection of vasoconstricting agents into the cervix, such as dilute vasopressin, placement of cervical stay sutures and placement of intracervical catheter for tamponade. In the presence of an ectopic pregnancy with a live fetus, preoperative injection of feticides into the ectopic pregnancy, may decrease the risk of bleeding/hemorrhage. For women not desirous of future fertility, where available, uterine artery embolization (UAE) may also help to reduce bleeding and improve the chances of resolving the ectopic pregnancy.

Hysterectomy is only employed as a last resort if the above two fails especially in the phase of prolonged and or continuous intractable heavy bleeding to safe the patient’s life.

 

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REFERENCES

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3.  Zakaria MA, Abdallah ME, Shavell VI, Berman JM, Diamond MP, Kmak DC. Conservative management of cervical ectopic pregnancy: utility of uterine artery embolization. Fertil Steril. 2011;95:872–6

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5.  Wang Y, Xu B, Dai S, Zhang Y, Duan Y, Sun C. An efficient conservative treatment modality for cervical pregnancy: angiographic uterine artery embolization followed by immediate curettage. Am J Obstet Gynecol. 2011;204:31