Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection

Abstract

Objective: To determine the accuracy of differential diagnosis by team consultation of abortion in progression, low-lying implantation/cervicoisthmic pregnancy, and cervical pregnancy (CP) in patients referred for suspicion of abnormal implantation on the lower segment and cervix of the uterus and to determine the efficacy of endoscopic surgery with uterine artery blockade followed by cervical evacuation in the treatment of confirmed CP.

Design: Prospective observational study under multiple-clinic and multiple-hospital cooperation.

Setting: Tertiary clinical and academic medical center.

Patient(s): Twenty-seven women with a tentative diagnosis of CP made at their primary gynecologists' offices from July 1999 to June 2003.

Intervention(s): Second-opinion ultrasound scanning with transabdominal and transvaginal approach and optional color Doppler use. For patients with confirmed CP, a new treatment modality with laparoscopy-assisted uterine artery ligation followed by hysteroscopic local endocervical resection to remove the ectopic pregnancy was employed. For patients with abortion in progression or low-lying implantation/cervicoisthmic pregnancy (non-CP) requiring termination, dilatation and curettage (D&C) was performed under transabdominal ultrasound guidance.

Main outcome measure(s): Fulfillment of ultrasound-based diagnostic criteria and operative course, convalescence, and commencement of menstruation in those patients with confirmed CP.

Result(s): Cervical pregnancy was diagnosed in six (22.2%) patients at <or=9-weeks' gestation, and they were all successfully treated without the need for adjuvant therapy. The mean operating time was 119 minutes, and the mean blood loss was 125 mL. Menstruation began a mean of 63 days after the treatment. Termination of non-CPs was achieved by a simple D&C.

Conclusion(s): Team consultation minimizes false-positive ultrasound-based diagnosis of CP. A single-step combination endoscopic operation is an effective uterus-preserving alternative in the management of CP.