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DOI: 10.1055/s-2003-42341
Viable Cervical Pregnancy Managed with Systemic Methotrexate, Uterine Artery Embolization, and Local Tamponade with Inflated Foley Catheter Balloon
Publikationsverlauf
Publikationsdatum:
18. September 2003 (online)
ABSTRACT
We present an unusual case of a primigravida with a viable cervical pregnancy diagnosed by transvaginal ultrasound and magnetic resonance imaging. Staggered conservative therapeutic measures included systemic high-dose Methotrexate with Folinic acid rescue followed by bilateral embolization of the uterine arteries in response to active cervical bleeding despite declining serum beta-human chorionic gonadotropin levels. Continued active cervical bleeding responded to local tamponade with an inflated Foley catheter balloon positioned within the cervical canal. Conservative treatment was successful, with complete resolution of the cervical pregnancy, resumption of normal menstrual cycles, and a normal transvaginal ultrasonographic appearance of the cervical canal, documented 8 weeks after the initial diagnosis. This case and review of the literature support that various staggered conservative hemostatic measures may be used at various points in which bleeding may occur in the conservative management algorithm of cervical pregnancy.
KEYWORDS
Cervical pregnancy - transvaginal ultrasound - magnetic resonance imaging - Methotrexate - uterine artery embolization - Foley catheter - tamponade
REFERENCES
- 1 Shinagawa S, Nagayama M. Cervical pregnancy as a possible sequela of induced abortion. Am J Obstet Gynecol . 1969; 105 282-284
- 2 Breen J L. A 21-year survey of 654 ectopic pregnancies. Am J Obstet Gynecol . 1970; 106 1004-1008
- 3 Yankowitz J, Leake J, Huggins G, Gazaway P, Gates E. Cervical ectopic pregnancy: review of the literature and report of a case treated by single-dose methotrexate therapy. Obstet Gynecol Surv . 1990; 45 405-414
- 4 Kobayashi M, Hellman L M, Fillisti L P. Ultrasound, an aid in the diagnosis of ectopic pregnancy. Am J Obstet Gynecol . 1969; 103 1131-1140
- 5 Raskin M M. Diagnosis of cervical pregnancy by ultrasound. Am J Obstet Gynecol . 1978; 130 234-235
- 6 Timor-Trisch I E, Monteagudo A, Mandeville E O, Peisner D B, Anaya G P, Pirrone E C. Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography. Am J Obstet Gynecol . 1994; 170 737-739
- 7 Monteagudo A, Tarricone N J, Timor-Trisch I E, Lerner J P. Successful transvaginal ultrasound-guided puncture and injection of a cervical pregnancy in a patient with simultaneous intrauterine pregnancy and a history of a previous cervical pregnancy. Ultrasound Obstet Gynecol . 1996; 8 381-386
- 8 Rafal R B, Kosovsky P A, Markisz J A. MR appearance of cervical pregnancy. J Comput Assist Tomogr . 1990; 14 482-484
- 9 Jung S E, Byun J Y, Lee J M, Choi B G, Hahn S T. Characteristic MR findings of cervical pregnancy. J Magn Reson Imaging . 2001; 13 918-922
- 10 Margolis K. Cervical pregnancy treated with a single intravenous administration of methotrexate plus oral folinic acid. Aust N Z J Obstet Gynaecol . 2000; 40 347-349
- 11 Hung T H, Chiu T H, Hsu J J, Chen K C, Hsieh C C, Hsieh T T. Sonographic evolution of a living cervical pregnancy treated with intra-amniotic instillation of methotrexate. J Ultrasound Med . 1997; 16 843-847
- 12 Kaplan B R, Brandt T, Javaheri G, Scommegna A. Nonsurgical treatment of a viable cervical pregnancy with intra-amniotic methotrexate. Fertil Steril . 1990; 53 941-943
- 13 Marston L M, Dotters D J, Katz V L. Methotrexate and angiographic embolization for conservative treatment of cervical pregnancy. South Med J . 1996; 89 246-248
- 14 Cosin J A, Bean M, Grow D, Wiczk H. The use of methotrexate and arterial embolization to avoid surgery in a case of cervical pregnancy. Fertil Steril . 1997; 67 1169-1171
- 15 Wong Y H, Liang E Y, Ng T K, Lau K Y. A cervical ectopic pregnancy managed by medical treatment and angiographic embolization. Aust N Z J Obstet Gynaecol . 1999; 39 493-496
- 16 Eblen A C, Pridham D D, Tatum C M. Conservative management of an 11-week cervical pregnancy: a case report. J Reprod Med . 1999; 44 61-64
- 17 Gun M, Mavrogiorgis M. Cervical ectopic pregnancy: a case report and literature review. Ultrasound Obstet Gynecol . 2002; 19 297-301
- 18 Van de Meerssche, Verdonk P, Jacquemyn Y, Serreyn R, Gerris J. Cervical pregnancy: three case reports and a review of the literature. Hum Reprod . 1995; 10 1850-1855
- 19 Nappi C, D'Elia A, Di Carlo C, Giordano E, De Placido G, Iaccarino V. Conservative treatment by angiographic uterine artery embolization of a 12 week cervical pregnancy. Hum Reprod . 1999; 14 1118-1121
- 20 Kung F T, Chang S Y. Efficacy of methotrexate treatment in viable and nonviable cervical pregnancies. Am J Obstet Gynecol . 1999; 181 1438-1444
- 21 Hung T H, Shau W Y, Hsieh T T, Hsu J J, Soong Y K, Jeng C J. Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review. Hum Reprod . 1998; 13 2636-2642
- 22 Kuppuswami N, Vindekilde J, Sethi C M, Seshadri M, Freese U E. Diagnosis and management of a cervical pregnancy. Obstet Gynecol . 1983; 61 651-653
- 23 Reginald P W, Reid J E, Paintin D B. Control of bleeding in cervical pregnancy: two case reports. Br J Obstet Gynaecol . 1985; 92 1199-1200
- 24 Patchell R D. Cervical pregnancy managed by balloon tamponade [letter]. Am J Obstet Gynecol . 1984; 149 107