1st Unit Obstetrics and Gynecology Santa Chiara University Hospital, Pisa, Italy.
Eur Rev Med Pharmacol Sci. 2021 Jun;25(12):4190-4197. doi: 10.26355/eurrev_202106_26121.
Cervical ectopic pregnancy (CEP) is a rare obstetric complication but carries the risk of life-threatening maternal hemorrhage.
A 43-year-old nulliparous woman, presented to the Emergency Room with vaginal bleeding. Initial quantitative serum β-hCG value was 85,220 mIU/mL. Obstetrical ultrasound demonstrated a single, live pregnancy of approximately 9 weeks' gestation located within the endocervix. After discussing different management options, intramuscular methotrexate injection in association with intra-amniotic chloride potassium installation was decided in order to preserve patient's desire for childbearing. Three months later, the patient was readmitted due to a massive vaginal bleeding. Angiographic uterine artery embolization (UAE) with an absorbable gelatin sponge was performed. After the procedure and two days of hospitalization, no significative bleeding was observed. The clinical course was uneventful, and serum human chorionic gonadotropin decreased immediately. The cervical mass gradually shrank and disappeared a month after UAE.
To preserve fertility in the management of CEP, clinicians could consider a combination of strategies, including UAE. A review of the current literature and possible treatment options for conservative CEP management are analyzed and discussed.
宫颈妊娠（CEP）是一种罕见的产科并发症，但存在危及生命的大出血风险。
一位 43 岁的初产妇，因阴道出血到急诊就诊。初始定量血清β-hCG 值为 85220mIU/mL。产科超声显示单一、活胎妊娠约 9 周，位于宫颈内口。在讨论了不同的治疗方案后，决定采用肌内注射甲氨蝶呤联合羊膜腔内氯化钾灌注，以保留患者的生育愿望。三个月后，患者因大量阴道出血再次入院。进行了血管造影子宫动脉栓塞术（UAE），并用可吸收明胶海绵进行栓塞。术后两天住院期间，未观察到明显出血。临床过程无异常，血清人绒毛膜促性腺激素立即下降。宫颈肿块在 UAE 后一个月逐渐缩小并消失。
为了在 CEP 的管理中保留生育能力，临床医生可以考虑联合使用 UAE 等多种策略。本文回顾了目前的文献，并对保守性 CEP 管理的可能治疗选择进行了分析和讨论。
