2018 Volume 34 Issue 2 Pages 282-290
Objective: To assess safe, accurate, and fertility-preserving treatment of cervical pregnancy (CP).
Design: We present two case reports and a literature review.
Patients: We evaluated a 39- and a 40-year-old woman in this study.
Interventions: Two patients underwent hysteroresectoscopic resection after systemic methotrexate (MTX) therapy.
Results: Case 1: The patient was referred to our hospital with suspected ectopic pregnancy at 6 weeks of gestation. Transvaginal ultrasonography (TVS) showed no gestational sac (GS) in the uterine body or the cervix; however, a power Doppler study showed hypervascularity of the cervix. She reported copious vaginal bleeding, and we inserted a Foley catheter in the cervical canal. Her serum human chorionic gonadotropin (hCG) level was 7634 mIU/mL. We anticipated a threatened abortion of the GS implanted in the cervical canal, and we initiated the systemic administration of MTX. Hysteroresectoscopic resection of the GS was performed 13 days after admission. All products of conception were completely removed, and she showed an uneventful postoperative course.
Case 2: The patient underwent consultation at 5 weeks 1 day of gestation for suspected CP. TVS demonstrated a GS measuring 8.3 mm in the cervical canal with no cardiac fetal activity, and the patient's serum hCG level was 5549 mIU/mL. We initiated the systemic administration of MTX, and hysteroresectoscopic resection of the GS was performed 12 days after admission. The patient showed an uneventful postoperative course.
Conclusion: Hysteroscopy provides direct visualization of the uterine cavity; thus, complete resection of the GS could be successfully performed in the 2 patients described in this report. We emphasize that hysteroresectoscopy is a safe, accurate, and fertility-preserving treatment.
