Chapter 33 - Cervical pregnancy

Summary

The use of transvaginal ultrasound has not only revolutionized the diagnosis of cervical pregnancy (CP) but also dramatically improved patient survival and allowed physicians to consider other fertility sparing treatment options. Management of CP depends on a number of factors. These include the gestational age, patient stability, the desire to maintain future fertility, and the available resources and expertise where the patient is managed. Generally, if the gestational age is less than 9 weeks without fetal cardiac activity, systemic chemotherapy in the form of methotrexate alone is the first line of treatment. If there is fetal heart activity and the gestational age is less than 12 weeks, intra-amniotic potassium chloride injection (3-5ml of 2 mEq/ml) should be done first, followed by systemic methotrexate. Uterine artery embolization (UAE) has been used for many years in the treatment of symptomatic uterine fibroids and in acute obstetric hemorrhage.