Bolaños-Bravo Henry Hernán, Ricaurte-Fajardo Andrés, Zarama-Márquez Fabio, Ricaurte-Sossa Andrés, Fajardo-Rivera Ruth, Chicaiza-Maya Rubén, Guerrero-Mejía Carlos Andrés
Departamento de Ginecología y Obstetricia, Hospital Universitario Departamental de Nariño, San Juan de Pasto (Colombia).
Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá D.C (Colombia).
Rev Colomb Obstet Ginecol. 2019 Dec;70(4):277-292. doi: 10.18597/rcog.3357.
To report a case of cervical pregnancy (CP) treated successfully with a conservative approach, and to conduct a review of the literature regarding conservative medical and surgical treatment.
Patient with cervical pregnancy treated pharmacologically with methotrexate (MTX) followed by dilation and curettage, with a satisfactory clinical course. A search of articles was conducted in Medline via PubMed, LILACS, SciElo and Google Scholar using the terms "cervical ectopic pregnancy," "conservative treatment," "curettage,» "methotrexate," "uterine artery embolization," "hysteroscopy." Reports and case series were selected of patients with cervical pregnancy diagnosed on ultrasound at any gestational age, subjected to conservative medical or surgical treatment.
A total of 22 studies were included; 95 patients with CP treated with MTX were identified, 93 of them successfully treated. The most frequent complication was bleeding in 12%; 26% required complementary surgical treatment. Increasingly, uterine artery embolization (UAE) is carried out preventatively (7 cases) before curettage or treatment with MTX. The hysteroscopy is another recent alternative (20 cases). Abdominal hysterectomy was required in two cases, one of which was a cervico-isthmic pregnancy.
Treatment with MTX continues to be the most frequent strategy. Dilation and curettage with endocervical plugging may be an option to consider in the emergency management of EP in primary care institutions. In institutions equipped with high complexity technology, uterine artery embolization before the surgical procedure and histeroscopy are options to be considered. Considering that early diagnosis of EP is now possible, multi-center studies comparing different management options are needed for better assessment of their safety and effectiveness.
报告一例采用保守方法成功治疗的宫颈妊娠病例，并对有关保守药物和手术治疗的文献进行综述。
对一名宫颈妊娠患者采用甲氨蝶呤（MTX）进行药物治疗，随后行刮宫术，临床过程令人满意。通过PubMed、LILACS、SciElo和谷歌学术在Medline上搜索文章，使用的关键词为“宫颈异位妊娠”“保守治疗”“刮宫术”“甲氨蝶呤”“子宫动脉栓塞”“宫腔镜检查”。选择了在任何孕周经超声诊断为宫颈妊娠并接受保守药物或手术治疗的患者的报告和病例系列。
共纳入22项研究；确定了95例接受MTX治疗的宫颈妊娠患者，其中93例成功治疗。最常见的并发症是出血，发生率为12%；26%的患者需要辅助手术治疗。越来越多地在刮宫术或MTX治疗前预防性地进行子宫动脉栓塞（UAE）（7例）。宫腔镜检查是另一种最近采用的方法（20例）。有两例需要行腹式子宫切除术，其中一例为宫颈峡部妊娠。
MTX治疗仍然是最常用的策略。在基层医疗机构对宫颈妊娠进行急诊处理时，宫颈内填塞刮宫术可能是一种可考虑的选择。在具备高复杂性技术的机构中，手术前进行子宫动脉栓塞和宫腔镜检查是可考虑的选择。鉴于现在能够早期诊断宫颈妊娠，需要进行多中心研究比较不同的处理方法，以便更好地评估其安全性和有效性。
