Volume 8, Issue 6 p. 373-380
Original Paper
Free Access

Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively

Dr D. Jurkovic

Corresponding Author

Dr D. Jurkovic

Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, London, UK

Department of Obstetrics and Gynaecology, King's College Hospital, Denmark Hill, London SE5 8RX, UKSearch for more papers by this author
E. Hacket

E. Hacket

Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, London, UK

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S. Campbell

S. Campbell

Department of Obstetrics and Gynaecology, St. George's Hospital Medical School, London, UK

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First published: 1 December 1996
Citations: 165

Abstract

We report two cases of cervical pregnancy which were diagnosed by ultrasound at 5 and 8 weeks' gestation. In both cases a gestational sac was visualized below the internal OS and color Doppler examination demonstrated peritrophoblastic blood flow characteristic of early implantation. Both patients were successfully treated with systemic methotrexate. Including these two cases, a total of 83 early cervical pregnancies have been reported in the literature over the last 10 years. Of these, 40 patients were primarily treated by conservative surgery, 40 by non-surgical methods using methotrexate or potassium chloride, and the remaining three by other chemotherapeutic agents. The likelihood of being cured was similar in the surgical and non-surgical groups (odds ratio 1.1; 9.5% confidence interval 0.4–3.2). However, patients who were primarily treated by surgery were more likely to sustain major hemorrhage (odds ratio 8.0; 95% confidence interval 2.4'26.5) and to require hysterectomy (odds ratio 7.4; 9.5% confidence interval 0.9'63.8) than those treated medically. This indicates that non-surgical methods should be used for primary treatment of cervical pregnancy, while surgery should be reserved for those patients in whom medical therapy is not successful. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology