April 26th, 2018

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Conservative Management of Cervical Pregnancy: A Report of Two Cases
Authors:  Vidhi Chaudhary, D.G.O., D.N.B., Poonam Sachdeva, D.G.O., D.N.B., Devender Kumar, M.D., Raksha Arora, M.D., Jyoti Banavaliker, M.S., and Muntaha Khan, M.D.
BACKGROUND: Cervical ectopic pregnancy is a rare form of ectopic pregnancy. Treatment of this clinical condition is controversial. Previously, hysterectomy was the mainstay of treatment, but in the recent past various conservative management approaches have been applied to preserve fertility. We report 2 such cases in which conservative approach was implemented.
CASES: Case 1 was an early, nonviable cervical pregnancy in which systemic methotrexate was used with success. Case 2 was a viable, advanced cervical pregnancy (at 11 weeks) in which a combination of uterine artery embolization and systemic methotrexate was used. Ultimately this patient required hysterectomy due to sudden massive hemorrhage on day 22 of intervention.

CONCLUSION: On reviewing our results and the literature, we conclude that uterine artery embolization with methotrexate is effective in reducing the ectopic cervical mass. However, there is always a risk of hemorrhage, which can be treated by either repeat uterine artery embolization alone or uterine artery embolization followed by curettage. Hysterectomy should be the last resort if all conservative methods fail.
Keywords:  ectopic pregnancy, methotrexate, uterine artery embolization
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