Departments of Obstetrics and Gynecology, Tufts University School of Medicine, Baystate Medical Center, Springfield, Massachusetts.
Obstet Gynecol. 2017 Jan;129(1):63-65. doi: 10.1097/AOG.0000000000001782.
Cervical ectopic pregnancy can lead to catastrophic hemorrhage, and may be managed conservatively with intra-amniotic methotrexate (MTX), systemic MTX, or both; surgical evacuation with or without balloon tamponade; and uterine artery embolization. However, some patients require hysterectomy, which has traditionally been performed abdominally.
A 39-year-old parous woman was diagnosed with cervical ectopic pregnancy at an estimated 7 1/7 weeks of gestation. Her β-hCG level remained at 29,433 milli-international units/mL, and the gestational sac persisted on ultrasonography after first intra-amniotic then multidose systemic MTX treatment. After a review of other fertility-sparing procedures, she chose definitive treatment with hysterectomy because she did not desire future childbearing. She underwent a successful vaginal hysterectomy, a novel approach for this condition.
Vaginal hysterectomy can be performed successfully for treatment of cervical ectopic pregnancy in patients who have completed childbearing and for whom conservative treatment has failed.
宫颈妊娠可导致灾难性出血，可通过羊膜内甲氨蝶呤（MTX）、全身 MTX 或两者联合保守治疗、伴有或不伴有球囊填塞的手术清除，以及子宫动脉栓塞术来治疗。然而，一些患者需要进行子宫切除术，传统上是通过腹部手术进行的。
一位 39 岁的经产妇，在妊娠约 7 1/7 周时被诊断为宫颈妊娠。她的β-hCG 水平仍为 29433 毫国际单位/毫升，在首次羊膜内然后多次全身 MTX 治疗后，超声检查仍可见妊娠囊。在对其他保留生育能力的手术进行审查后，她选择了子宫切除术作为明确的治疗方法，因为她不希望再生育。她成功地进行了阴道子宫切除术，这是一种治疗宫颈妊娠的新方法。
对于已完成生育且保守治疗失败的患者，阴道子宫切除术可成功治疗宫颈妊娠。
