子宮頸管妊娠にバソプレシン局注療法および子宮鏡観察が有用であった４症例

抄録

Background: Treatment options for cervical ectopic pregnancy have been reported to include methotrexate therapy or a combination of uterine artery embolization and hysteroscopic surgery. There are concerns about the prolonged duration of treatment and the risk of decreased fertility with these methods. We report four cases of cervical ectopic pregnancy in which vasopressin was locally injected around the gestational sac under transvaginal ultrasound guidance, and hysteroscopic observation was performed after the gestational sac was removed.

Methods: The gestation period was 5-6 weeks, blood human chorionic gonadotropin (HCG) level was 3,000-40,000 IU/L, and fetal heartbeat was confirmed in two cases. Diluted vasopressin with saline was locally injected around the gestational sac under ultrasound guidance. The endpoints of vasopressin administration were loss of blood flow to the gestational sac and fetal cardiac arrest. After the gestational sac was removed, hysteroscopy was performed to remove residual tissue and stop bleeding.

Results: In all cases, the gestational sac was detached only by cervical dilation before hysteroscopy. Hysteroscopic observation revealed residual tissue in three cases and removed it with blunt manipulation. Bleeding was observed and stopped in one case. Intraoperative blood loss was 1-20 g, and all the patients were discharged from the hospital on the first postoperative day. HCG-negative status was confirmed between 29 and 50 days postoperatively, and there was no persistent ectopic pregnancy.

Discussion: Local vasopressin injection around the gestational sac is highly feasible because of short-term treatment period and it may not affect fertility. Moreover, adding hysteroscopy may improve safety by ensuring removal of residual tissue and hemostasis.

Conclusion: Local vasopressin injection around the gestational sac and hysteroscopic observation may become standard treatments for cervical ectopic pregnancy.