Cervical pregnancy: the importance of early diagnosis and treatment

Abstract

Study objective: To report the evolution and outcome of 12 cases of cervical pregnancy.

Design: Retrospective study (Canadian Task Force classification II-3).

Setting: University teaching hospitals.

Patients: Twelve women with cervical pregnancy.

Interventions: Methotrexate, uterine artery embolization, curettage, ligation of the descending branch of uterine vessels, or hysterectomy.

Measurements and main results: The main outcome measure was success of conservative management. From January 1985 through December 2005, we encountered 12 cases of cervical pregnancy. The final diagnosis was established by ultrasound, operative findings, and histopathology. We obtained information from the medical records of the patients regarding when and how the diagnosis was made, the characteristics of the pregnancy, and treatment modalities. The prevalence of cervical pregnancy was 1:10,000 deliveries. The patients' history revealed previous curettage in 6 (50%) and cesarean delivery in 2 others (16.7%). Four patients (33.3%) initially not diagnosed to have cervical pregnancy required a hysterectomy. Initial diagnosis of cervical pregnancy was correct in 5 patients. They were treated with methotrexate, uterine artery embolization, curettage, or ligation of the descending branch of uterine vessels. None of these patients required blood transfusion or hysterectomy.

Conclusion: The success of conservative treatment for cervical pregnancy depends on the diagnostic accuracy of the initial ultrasound. Correct diagnosis would reduce the chance of hysterectomy or blood transfusion.