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      Embarazo cervical


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

          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; 95% 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; 95% 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.
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            Ectopic pregnancy within a cesarean delivery scar: a case report.

            The implantation of a pregnancy within the scar of a previous cesarean delivery is the rarest of ectopic pregnancy locations. If it is diagnosed early, treatment options are capable of preserving the uterus and subsequent fertility. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity.
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              Cervical pregnancy: past and future.

              Cervical pregnancy (CP) is a rare life-threatening form of ectopic pregnancy occurring in 1 of 8628 deliveries. We reviewed 117 cases of CP in the English language literature from 1978 and added three cases from our department. Etiology of CP is still unknown, but there is evidence for its association with cervicouterine instrumentation. The possible role of embryo chromosomal abnormality in the CP etiology is considered. Sonography improved pretreatment diagnosis up to 81.8 percent. Obligatory sonographic criteria of CP include endocervical localization of the gestational sac and trophoblastic invasion. About 60 percent of cervical pregnancies are with a viable fetus. The majority of patients with a cervical pregnancy are women with low parity, thus, the current treatment trend is to preserve their reproductive function. The main problem of conservative treatment is life-threatening hemorrhage after pregnancy evacuation. The use of cervical canal tamponade with a Foley catheter balloon led to reliable hemostasis in 92.3 percent of cases in which this method was used. Early diagnosis of CP allowed for treatment by chemotherapy in 32 cases, with an 81.3 percent success rate. Serial beta-human chorionic gonadotropin levels and transvaginal ultrasound with color Doppler are used to monitor therapy. Another conservative treatment modality is local intrasac KCI injections. Hysterectomy is recommended mostly for second and third trimester cervical pregnancy, or for uncontrolled bleeding.

                Author and article information

                Role: ND
                Revista de Obstetricia y Ginecología de Venezuela
                Rev Obstet Ginecol Venez
                Sociedad de Obstetricia y Ginecología de Venezuela (Caracas )
                December 2002
                : 62
                : 4
                : 261-267



                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0048-7732&lng=en

                Obstetrics & Gynecology
                Obstetrics & Gynecology


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