Organ-preserving treatment in progressive cervical pregnancy. A clinical case

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This article describes a rare clinical case of progressive ectopic pregnancy in the cervix in a female patient of reproductive age, the incidence of which is less than 1% of all ectopic pregnancies. The exact etiopathogenetic mechanism of cervical pregnancy is still unknown. Misdiagnosis of cervical pregnancy can lead to a fatal outcome with massive bleeding and is associated with the risk of hysterectomy and complete loss of fertility in patients of reproductive age.

This article presents the results of a pathoanatomical study confirming the diagnosis and adequacy of the performed therapeutic measures. We demonstrated the complexity of diagnosing this pathology, as well as the possibility and conditions for performing an organ-preserving surgery. The presented clinical case will allow doctors of various specialties to know more about this rare form of ectopic pregnancy, to suspect and successfully diagnose cervical pregnancy in the early stages of gestation, which will avoid or reduce the development of severe and sometimes life-threatening complications.

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作者简介

Anna Sulima

V.I. Vernadsky Crimean Federal University; Simferopol City Clinical Maternity Hospital No. 1

Email: gsulima@yandex.ru
ORCID iD: 0000-0002-2671-6985
SPIN 代码: 2232-0458
Scopus 作者 ID: 57214970506
Researcher ID: P-3191-2015

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Simferopol; Simferopol

Zoya Gunar

Simferopol City Clinical Maternity Hospital No. 1

Email: gunar_z@mail.ru
ORCID iD: 0000-0002-8885-2130
俄罗斯联邦, Simferopol

Alexandr Adamov

V.I. Vernadsky Crimean Federal University

Email: adamovalexandr.2021@gmail.com
ORCID iD: 0000-0003-3312-0319
SPIN 代码: 2181-8876
Scopus 作者 ID: 57957491400
俄罗斯联邦, Simferopol

Andrey Gordeychik

N.A. Semashko Republican Clinical Hospital

Email: androng1818@mail.ru
俄罗斯联邦, Simferopol

Azat Mkrtchian

N.A. Semashko Republican Clinical Hospital

Email: mkrtchyan@list.ru
ORCID iD: 0000-0002-6568-5632
SPIN 代码: 5721-0534
俄罗斯联邦, Simferopol

Aleksandra Davydova

V.I. Vernadsky Crimean Federal University

Email: akzag@mail.ru
ORCID iD: 0000-0003-0843-1465
SPIN 代码: 9796-9984

MD, Cand. Sci. (Med.), Assistant Professor

俄罗斯联邦, Simferopol

Nataly Tkacheva

V.I. Vernadsky Crimean Federal University

编辑信件的主要联系方式.
Email: na1tka@rambler.ru
ORCID iD: 0000-0001-8212-8566
SPIN 代码: 6369-4948

MD, Cand. Sci. (Med.), Assistant Professor

俄罗斯联邦, Simferopol

参考

  1. Anikin SS, Sulima AN, Zabolotnov VA, et al. Osobennosti khirurgicheskogo lecheniya zhenshchin s vnematochnoi beremennost’yu i ego vliyanie na reproduktivnuyu funktsiyu. In: Besplodnyi brak. Vspomogatel’nye reproduktivnye tekhnologii: mezhregional’naya nauchno-prakticheskaya konferentsiya; may 14-16. Rostov-on-Don; 2017. (In Russ.)
  2. Tanos V, ElAkhras S, Kaya B. Hysteroscopic management of cervical pregnancy: case series and review of the literature. J Gynecol Obstet Hum Reprod. 2019;48(4):247–253. doi: 10.1016/j.jogoh.2018.05.001
  3. Alalade AO, Smith FJE, Kendall CE, Odejinmi F. Evidence-based management of non-tubal ectopic pregnancies. J Obstet Gynaecol. 2017;37(8):982–991. doi: 10.1080/01443615.2017.1323852
  4. Gomel V. From laparotomy to laparoscopy to in vitro fertilization. Fertil Steril. 2019;112(2):183–196. doi: 10.1016/j.fertnstert.2019.06.028
  5. Rybalka AN, Sulima AN, Rumyantseva ZS, et al. Ectopic pregnancy. Simferopol; 2021. (In Russ.)
  6. Fetishcheva LE, Ushakova GA, Petrich LN. Ectopic pregnancy: risk factors, a problems of diagnosis, treatment, the restoration of fertility. Mother and Baby in Kuzbass. 2017;1(68):16–24. (In Russ.)
  7. Di Tizio L, Spina MR, Gustapane S, et al. Interstitial pregnancy: from medical to surgical approach-report of three cases. Case Rep Obstet Gynecol. 2018;2018. doi: 10.1155/2018/2815871
  8. Dolinko AV, Vrees RA, Frishman GN. Non-tubal ectopic pregnancies: overview and treatment via local injection. J Minim Invasive Gynecol. 2018;25(2):287–296. doi: 10.1016/j.jmig.2017.07.008
  9. Stabile G, Romano F, Buonomo F, et al. Conservative treatment of interstitial ectopic pregnancy with the combination of mifepristone and methotrexate: our experience and review of the literature. Biomed Res Int. 2020;2020. doi: 10.1155/2020/ 8703496
  10. Giampaolino P, de Rosa N, Morra I, et al. Management of cesarean scar pregnancy: a single-institution retrospective review. Biomed Res Int. 2018;2018. doi: 10.1155/2018/6486407
  11. Mutiso SK, Oindi FM, Hacking N, et al. Uterine necrosis after uterine artery embolization for symptomatic fibroids. Case Rep Obstet Gynecol. 2018;2018. doi: 10.1155/2018/9621741
  12. Stabile G, Mangino FP, Romano F, et al. Ectopic pregnancy on the cervix: a method of treatment. Medicine (Kaunas). 2020;56(6):293. doi: 10.3390/medicina56060293
  13. Jurkovic D, Hacket E, Campbell S. Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively. Ultrasound Obstet Gynecol. 1996;8(6):373–380. doi: 10.1046/j.1469-0705.1997.08060373.x
  14. Nemat AbdulRahman AbdulJabbar, Saquib S, Mohammed Talha WE. Successful management of abdominal pregnancy: two case reports. Oman Med J. 2018;33(2):171–175. doi: 10.5001/omj.2018.32
  15. Elmokadem AH, Abdel-Wahab RM, El-Zayadi AA, et al. Uterine artery embolization and methotrexate infusion as sole management for caesarean scar and cervical ectopic pregnancies: a single-center experience and literature review. Can Assoc Radiol J. 2019;70(3):307–316. doi: 10.1016/j.carj.2018.12.002
  16. Mangino FP, Romano F, Di Lorenzo G, et al. Total hysteroscopic treatment of cervical pregnancy: the 2-step technique. J Minim Invasive Gynecol. 2019;26(6):1011–1012. doi: 10.1016/j.jmig.2019.01.009
  17. Long Y, Zhu H, Hu Y, et al. Interventions for non-tubal ectopic pregnancy. Cochrane Database Syst Rev. 2020;7(7). doi: 10.1002/14651858.CD011174.pub2

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2. Fig. 1. Ultrasound picture of progressive cervical pregnancy in patient L. at 5–6 weeks of gestation upon admission to the gynecological hospital (arrows indicate: 1, uterus; 2, cervix with a fetal egg)

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3. Fig. 2. Angiograms before (a) and after (b) uterine artery embolization on the right and left in patient L.

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4. Fig. 3. Fragments of the cervix and the fetal egg elements among the blood corpuscles. Hematoxylin and eosin staining, zoom ×100

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5. Fig. 4. Decidual tissue with tangles of spiral arteries, light secretory glands, and focal lymphocytic infiltration. Hematoxylin and eosin staining, zoom ×40

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6. Fig. 5. Ectocervix fragments covered with a multilayer squamous epithelium, chorionic villi and trophoblast cells adhering. Hematoxylin and eosin staining, zoom ×100

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