COMBINATION TREATMENT IN WOMEN WITH CERVICAL PREGNANCY

Objective. To evaluate the efficiency of combination organ-saving treatment in patients with cervical pregnancy. Subjects and methods. A follow-up study was made in 23 women with cervical pregnancy, admitted to the Department of Operative Gynecology of the Center from 2005 to September 2011. The studies encompassed ultrasound using a transvaginal color Doppler probe, magnetic resonance imaging to visualize an ovum; determination of the borders between the chorion and the cervical stroma, as well as the degree of blood flow in the chorionic area; estimation of the time course of changes in the β-subunit of human chorionic gonadotropin (β-HCG) in the serum; general clinical examinations; endoscopic studies, such as hysteroscopy, hysteroresectoscopy with a diagnostic examination of the material removed. The patients’ mean age was 35±5.9 years (range 25—43 years). The gestation length on admission was 5 to 9 weeks and averaged 6.2 ±0.9 weeks. Results. The patients with cervical ovum location received an average of 50 mg of methotrexate intravenously every 48 hours; leucovorin was given in a dose of 6 mg intramuscularly 28 hours after methotrexate administration. The total dose of the administered methotrexate ranged from 200 to 300 mg and depended on patient weight, gestation length, and chorionic blood flow intensity. During the cytostatic treatment, 19 women of this group could achieve decreases in serum β-HCG and chorionic blood flow to the minimum values (less than 7000 IU/l) and a significant reduction in chorionic vascularization, as evidenced by Doppler study. The ovum was removed using histeroresectoscopy under intravenous anesthesia. The surgical duration averaged 20. In the period 2005—2011, the long-term results were traced in 10 of the 15 women receiving the combination therapy for cervical pregnancy. Four of them were found to have spontaneous pregnancy giving birth to healthy babies, no pregnancy occurred in 5 women. One woman had in vitro fertilization failure. A recurrent cervical pregnancy occurred in none of the cases examined. Conclusion. The results of organ-saving treatment in patients with cervical pregnancy demonstrated the high efficiency of a differential approach to managing this group of patients, by using preoperative chemotherapy and monitoring β-HCG levels, blood parameters, and the status of the chorion and embryo in combination of mini-invasive surgical techniques for removal of the ovum and its bed coagulation.

cervical pregnancy, methotrexate, β-subunit of human chorionic gonadotropin, transvaginal ultrasound study, hysteroresectoscopy