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Ginecología y Obstetricia de México

Federación Mexicana de Ginecología y Obstetricia, A.C.
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2006, Number 11

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Ginecol Obstet Mex 2006; 74 (11)

Cervical pregnancy. A report of a case and literature review

Vidal VMC, Trujillo GJJ, Grover PF
Full text How to cite this article

Language: Spanish
References: 10
Page: 594-598
PDF size: 297.72 Kb.


Key words:

cervical pregnancy, ectopic pregnancy and methotrexate.

ABSTRACT

The cervical pregnancy is a rare clinical illness among the ectopic pregnancies; the diagnosis at the moment is made by means of ultrasonography, which shows an empty uterus and a gestation in cervical channel. At the moment the preservative treatment can be made with methotrexate, without determining of precise way the factors of fault for this handling, leaving the single surgical treatment in emergency situations, avoiding the uncontrollable haemorrhage. This paper reports the case of a patient with a cervical pregnancy of nine weeks, live, with initial determination of corionic gonadotrophin hormone of 68,919 mUI/mL; reason why it is decided to interrupt the gestation being applied two doses of methotrexate; first IV of 85 mg and second with intraamniotic application. The evolution of the gestation was towards the involution and absorption of the gestational coat, the sub-unit concentrations corionic gonadotrophin hormone beta presented decrement, until undetectable, with good clinical and functional results. The gestational coat was reduced, the embryo lost beat and the gonadotrophin were in decrement until zero, with clinical evolution with stained solely haematic, without haematological and functional repercussions. Criteria of fault of the preservative treatment with methotrexate are not defined, although due the peculiarity of this illness, it is not possible to make a more extensive study, but by the reproductive benefit in young patients, it would be adapted to take it in to account like option instead of the hysterectomy.


REFERENCES

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  2. Dart RG, Burke G, Dart L. Subclasification of indeterminate pelvic ultrasonography: prospective evaluation of the risk or ectopic pregnancy. Ann Emerg Med 2002;39:382-8.

  3. Bih-Chwen Hsieh, Jiann-Loung Hwang et al. Cervical pregnancy after in vitro fertilization and embryo transfer successfully treated with methotrexate and intracervical injection vasopressin. Acta Obstet Gynecol Scand 2004;83:112-4.

  4. Sherer DM, Dalloul M, Santoso P, Stimphil R, Sokolovski MR, Abulafia O. Complete abortion of a nonviable cervical pregnancy following methotrexate treatment. Am J Perinatology 2004;21:223-6.

  5. Hidalgo LA. Management of cervical pregnancy: risk factors for failed systemic methotrexate. J Perinat Med 2004;32(2):184-6.

  6. Matorras R, García A. Tratamiento no quirúrgico del embarazo ectópico tubárico. Prog Obst Gin 1997;40:379-400.

  7. Fu Tsai K, Shiuh Young C. Efficacy of methotrexate treatment in viable and nonviable cervical pregnancies. Am J Obstet Gynecol 1999;181:1438-44.

  8. Bai SW, JS Lee. Failed methotrexate treatment of cervical pregnancy. Predictive factors. J Reprod Med 2002;47:483.

  9. Hung TH, WY Shau, TT Hsieh. Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy. Gynecol Obstet Invest 2000;50:139.

  10. Hajenius PJ, Roos D, Ankum WM. Are serum human chorionic gonadothopin clearance curves of use in monitoring methotrexate treatment in cervical pregnancy? Fertil Steril 1998;70:362.




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Ginecol Obstet Mex. 2006;74