Hysteroscopic management of cervical pregnancy: Case series and review of the literature

Abstract

Purpose: To evaluate the hysteroscopic management on cervical pregnancy.

Materials and methods: A case series report and literature review on patients with early first trimester cervical pregnancy (CP) treated by hysteroscopy. The symptoms upon admission, β-hCG levels, hysteroscopy technique, blood loss and operation outcomes were presented.

Results: Four patients with early CP between 5 and 7 weeks were successfully managed with operative hysteroscopy. Three out of four patients had at least one risk factor for cervical ectopic pregnancy. Two patients were diagnosed on routine examinations and the other two presented with vaginal spotting and pelvic pain. Mechanical hysteroscopy was used in three patients while one case was managed by a 10mm resectoscope. Three women discharged home on the same day and one patient 24h after the operation. Literature review revealed 16 publications of cervical pregnancy managed with operative hysteroscopy. 14 articles demonstrated single case reports and two papers were CP case series. Hysteroscopic surgery was successfully reported in 12 cases as a sole treatment, in seven cases after failure of methotrexate treatment and in eight cases as a combined treatment with uterine artery embolization.

Conclusions: Our case series demonstrated that operative hysteroscopy can be used as a sole treatment in early, less than 8-week CPs with safety. Literature review demonstrated that most of the early first trimester CP cases were treated by hysteroscopy and the rest after failure of methotrexate treatment or in combination with uterine artery embolization.

Keywords: Cervical pregnancy; Hysteroscopy; Methotrexate; Uterine artery embolization.