Abstract Title

CERVICAL PREGNANCY: A LIFE-THREATENING GESTATION

Presenter Name

Rita Golikeri, Hayley Marshall

Abstract

When a pregnancy implants someplace other than inside the uterus it is referred to as an ectopic pregnancy. In rare instances a fertilized ovum may implant in the cervical canal and is called a cervical ectopic pregnancy (CEP). CEP occurs in 1:9000 pregnancies. CEP can be organ and life threatening and have significant effects on future fertility. We describe a case that was managed with methotrexate and uterine artery embolization (UAE) instead of surgery. This allowed for preservation of her uterus and potential future childbearing.

Purpose (a):

The purpose of this case report is to share our experience with a less common but possibly fertility-sparing therapy. Our case is of a 35 year-old G3P2 woman with a CEP who presented with profuse vaginal bleeding. Since the patient desired future fertility, she was treated with an ultrasound-guided UAE instead of a hysterectomy, followed by use of methotrexate (MTX) and leucovorin.

Methods (b):

The patient’s chart was reviewed to gather information regarding her history and hospital management course. This 35 year-old G3P2 female presented with a two week history of active vaginal bleeding, symptomatic anemia, and a positive home pregnancy test. Transvaginal ultrasound (TVUS) revealed an 8-week pregnancy within the endocervical canal, consistent with a CEP. Definitive treatment for a CEP is hysterectomy, but as the patient desired future fertility, a less invasive option of UAE followed by MTX and leucovorin was chosen. She received three doses of MTX and leucovorin, and her serum b-hCG was followed to zero.

Results (c):

The patient underwent successful UAE. CEP was not seen on TVUS five days after treatment began. She showed appropriate decreases in serum b-hCG and transitioned to outpatient care. With successful non-invasive elimination of the CEP, this patient avoided a potentially fatal hemorrhage and possibly retained fertility. The patient was still awaiting spontaneous menses one month after the procedure. While a definitive cause is unknown, as in our patient, several theories exist for its cause. Risk factors include cervico-uterine instrumentation, in vitro fertilization, and history of pelvic inflammatory disease. Historically, treatment of CEP was with hysterectomy, but other approaches have been used recently in order to avoid infertility and surgical morbidity.

Conclusions (d):

It is important to recognize the diagnosis of CEP, as it can be mistaken for other conditions, such as a missed abortion proximal to the cervix. The use of UAE is an emerging trend in the management of CEP due to its high success rate and preservation of future fertility. Literature on the subject is limited to observational studies and anecdotal evidence. Complications of UAE include permanent amenorrhea, claudication and other issues if another artery is embolized. Reporting of this and similar cases may contribute to improved methods of managing CEP.

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CERVICAL PREGNANCY: A LIFE-THREATENING GESTATION

When a pregnancy implants someplace other than inside the uterus it is referred to as an ectopic pregnancy. In rare instances a fertilized ovum may implant in the cervical canal and is called a cervical ectopic pregnancy (CEP). CEP occurs in 1:9000 pregnancies. CEP can be organ and life threatening and have significant effects on future fertility. We describe a case that was managed with methotrexate and uterine artery embolization (UAE) instead of surgery. This allowed for preservation of her uterus and potential future childbearing.