Cervical pregnancy (CP) is a rare form of ectopic pregnancy. It is defined as the implantation of the blastocyst in the endocervix. The cervix is a highly vascularized area, which is potentially suitable for the implantation of a fertilized ovum. However, it is also extremely vulnerable to heavy bleeding due to its suboptimal hemostatic mechanical capacity and its insusceptibility to respond to uterotonic agents. Despite its rarity, CP is a rare but potentially life-threatening condition because, when undiagnosed, it carries the potential risk of large-scale blood loss. In previous decades, a diagnosis was made when dilation and curettage, performed as a result of a presumably incomplete abortion, resulted in sudden and uncontrollable hemorrhage. To save the patient’s life, the treatment often required was an hysterectomy. Today, cervical pregnancy can be diagnosed through an ultrasound during the first trimester of pregnancy. This recognition at an early stage has led to a development of more conservative treatments, with the objective of preserving fertility. Different approaches have been implemented, but due to the rarity of this condition standard recommendations have not yet been elucidated. Recently, hysteroscopic resection of ectopic CP was described as an effective and fertility-preserving surgical therapy, having been used alone or in combination with another complementary therapy. Although some authors dispute its complementary function with methotrexate (MTX), others believe that it could be used as a rescue method in the case of MTX failure. However, to date, there has been no consensus on the exact role of hysteroscopy in CP.
Cervical Ectopic Pregnancy: The Role of Hysteroscopy
Salvatore Giovanni Vitale;
2018-01-01
Abstract
Cervical pregnancy (CP) is a rare form of ectopic pregnancy. It is defined as the implantation of the blastocyst in the endocervix. The cervix is a highly vascularized area, which is potentially suitable for the implantation of a fertilized ovum. However, it is also extremely vulnerable to heavy bleeding due to its suboptimal hemostatic mechanical capacity and its insusceptibility to respond to uterotonic agents. Despite its rarity, CP is a rare but potentially life-threatening condition because, when undiagnosed, it carries the potential risk of large-scale blood loss. In previous decades, a diagnosis was made when dilation and curettage, performed as a result of a presumably incomplete abortion, resulted in sudden and uncontrollable hemorrhage. To save the patient’s life, the treatment often required was an hysterectomy. Today, cervical pregnancy can be diagnosed through an ultrasound during the first trimester of pregnancy. This recognition at an early stage has led to a development of more conservative treatments, with the objective of preserving fertility. Different approaches have been implemented, but due to the rarity of this condition standard recommendations have not yet been elucidated. Recently, hysteroscopic resection of ectopic CP was described as an effective and fertility-preserving surgical therapy, having been used alone or in combination with another complementary therapy. Although some authors dispute its complementary function with methotrexate (MTX), others believe that it could be used as a rescue method in the case of MTX failure. However, to date, there has been no consensus on the exact role of hysteroscopy in CP.
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