Hassiakos D, Bakas P, Creatsas G
2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Alexandras Avenue 108, 11522 Athens, Greece.
Arch Gynecol Obstet. 2005 Jan;271(1):69-72. doi: 10.1007/s00404-003-0567-9. Epub 2004 Jan 14.
Aim of the study was to investigate the efficacy of single transvaginal ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy with concurrent review of the literature.
Six patients with cervical pregnancy are included in the study. All patients were treated with single transvaginal ultrasound-guided intraamniotic installation of 70 mg of methotrexate plus folic acid p.o. The main presenting symptoms were mild to moderate vaginal bleeding and lower abdominal cramp-like pain, resembling the clinical presentation of a threatened abortion. The typical ultrasound findings were the absence of intrauterine gestational sac and the detection of a gestational sac within the cervical canal, invading the anterior or the posterior wall of the cervix and normal appearance of the adnexa, bilaterally. The hourglass-shaped cervix was not characteristic at 5 weeks of gestation but it was at 8 weeks of gestation.
Ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy appears to be an effective and safe method but the choice of the method should be depended on the gestational age of cervical pregnancy, the presence of active bleeding or not and its severity, the desire for preservation of future fertility, the presence of coexisting valuable intrauterine pregnancy and the experience of the physician in charge.
本研究旨在探讨经阴道超声引导下单次羊膜腔内注射甲氨蝶呤治疗宫颈妊娠的疗效，并对相关文献进行综述。
本研究纳入6例宫颈妊娠患者。所有患者均接受经阴道超声引导下单次羊膜腔内注射70mg甲氨蝶呤加口服叶酸治疗。主要临床表现为轻度至中度阴道出血及下腹部痉挛样疼痛，类似先兆流产的临床表现。典型的超声表现为宫内未见妊娠囊，宫颈管内见妊娠囊，侵犯宫颈前壁或后壁，双侧附件外观正常。妊娠5周时宫颈呈沙漏形不典型，但妊娠8周时典型。
经阴道超声引导下羊膜腔内注射甲氨蝶呤治疗宫颈妊娠似乎是一种有效且安全的方法，但该方法的选择应取决于宫颈妊娠的孕周、是否存在活动性出血及其严重程度、对保留未来生育能力的意愿、是否存在并存的珍贵宫内妊娠以及主管医生的经验。
