Skip to main content
SpringerLink
Log in

Cervical Pregnancy

  • Chapter
  • First Online:
Management and Therapy of Early Pregnancy Complications

Abstract

Cervical ectopic pregnancy is a rare event with an incidence of 1 in 1000–18,000 pregnancies. It can cause massive hemorrhage requiring a hysterectomy. However, today most cervical pregnancies can be diagnosed early allowing fertility-sparing treatments. This chapter reviews the diagnosis and management of cervical ectopic pregnancy. We conclude that systemic multidose methotrexate results in high rates of success with no long-term effects on future fertility. More invasive treatments are indicated for cases that have failed methotrexate or have contraindications to its use.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ushakov FB, Elchalal U, Aceman PJ, Schenker JG (1997) Cervical pregnancy: past and future. Obstet Gynecol Surv 52(1):45–59

    Article  CAS  PubMed  Google Scholar 

  2. Parente JT, Ou CS, Levy J, Legatt E (1983) Cervical pregnancy analysis: a review and report of five cases. Obstet Gynecol 62(1):79–82

    CAS  PubMed  Google Scholar 

  3. Vela G, Tulandi T (2007) Cervical pregnancy: the importance of early diagnosis and treatment. J Minim Invasive Gynecol 14(4):481–484

    Article  PubMed  Google Scholar 

  4. Shavell VI, Abdallah ME, Zakaria MA, Berman JM, Diamond MP, Puscheck EE (2012) Misdiagnosis of cervical ectopic pregnancy. Arch Gynecol Obstet 285(2):423–426

    Article  PubMed  Google Scholar 

  5. Yankowitz J, Leake J, Huggins G, Gazaway P, Gates E (1990) Cervical ectopic pregnancy: review of the literature and report of a case treated by single-dose methotrexate therapy. Obstet Gynecol Surv 45(7):405–414

    Article  CAS  PubMed  Google Scholar 

  6. Cipullo L, Cassese S, Fasolino L, Fasolino MC, Fasolino A (2008) Cervical pregnancy: a case series and a review of current clinical practice. Eur J Contracept Reprod Health Care 13(3):313–319

    Article  PubMed  Google Scholar 

  7. Martinelli P, Maruotti GM, Oppedisano R, Agangi A, Mazzarelli LL, Votino C et al (2007) Is uterine artery embolization for cervical ectopic pregnancy always safe? J Minim Invasive Gynecol 14(6):758–763

    Article  PubMed  Google Scholar 

  8. Marcovici I, Rosenzweig BA, Brill AI, Khan M, Scommegna A (1994) Cervical pregnancy: case reports and a current literature review. Obstet Gynecol Surv 49(1):49–55

    Article  CAS  PubMed  Google Scholar 

  9. Vilos G, Abu-Rafea B, Kozak R (2005) Safe resectoscopic evacuation of a 10-week viable cervical pregnancy after transfemoral bilateral uterine artery embolization. Fertil Steril 84(2):509

    Article  PubMed  Google Scholar 

  10. Hung TH, Jeng CJ, Yang YC, Wang KG, Lan CC (1996) Treatment of cervical pregnancy with methotrexate. Int J Gynaecol Obstet 53(3):243–247

    Article  CAS  PubMed  Google Scholar 

  11. Kouliev T, Cervenka K (2010) Emergency ultrasound in cervical ectopic pregnancy. J Emerg Med 38(1):55–56

    Article  PubMed  Google Scholar 

  12. Ginsburg ES, Frates MC, Rein MS, Fox JH, Hornstein MD, Friedman AJ (1994) Early diagnosis and treatment of cervical pregnancy in an in vitro fertilization program. Fertil Steril 61(5):966–969

    Article  CAS  PubMed  Google Scholar 

  13. Boyko TR, O’brien JF (2001) Cervical pregnancy: a case report. Ann Emerg Med 38(2):177–180

    Article  CAS  PubMed  Google Scholar 

  14. Pisarska MD, Carson SA (1999) Incidence and risk factors for ectopic pregnancy. Clin Obstet Gynecol 42:2–8

    Article  CAS  PubMed  Google Scholar 

  15. Chetty M, Elson J (2009) Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol 23(4):529–538

    Article  PubMed  Google Scholar 

  16. Paalman RJ, Mc Elin TW (1959) Cervical pregnancy. Review of the literature and presentation of cases. Am J Obstet Gynecol 77:1261–1270

    Article  CAS  PubMed  Google Scholar 

  17. Kobayashi M, Hellman LM, Fillisti LP (1969) Ultrasound: and aid in the diagnosis of ectopic pregnancy. Am J Obstet Gynecol 103(8):1131–1140

    Article  CAS  PubMed  Google Scholar 

  18. Raskin MM (1978) Diagnosis of cervical pregnancy by ultrasound: a case report. Am J Obstet Gynecol 130:234–235

    Article  CAS  PubMed  Google Scholar 

  19. Timor-Tritsch IE, Monteagudo A, Mandeville EO, Peisner DB, Anaya GP, Pirrone EC (1994) Successful management of a viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography. Am J Obstet Gynecol 170(3):737–739

    Article  CAS  PubMed  Google Scholar 

  20. Jurkovic D, Hacket E, Campbell S (1996) Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively. Ultrasound Obstet Gynecol 8(6):373–380

    Article  CAS  PubMed  Google Scholar 

  21. Sherer DM, Gorelick C, Dalloul M, Sokolovski M, Kheyman M, Kakamanu S et al (2008) Three-dimensional sonographic findings of a cervical pregnancy. J Ultrasound Med 27(1):155–158

    PubMed  Google Scholar 

  22. Jung SE, Byun JY, Lee JM, Choi BG, Hahn ST (2001) Characteristic MR findings of cervical pregnancy. J Magn Reson Imaging 13(6):918–922

    Article  CAS  PubMed  Google Scholar 

  23. Little EA, Moussavian B, Horrow MM (2010) Cesarean delivery scar ectopic pregnancy. Ultrasound Q 26(2):107–109

    Article  PubMed  Google Scholar 

  24. Tan G, Chong YS, Biswas A (2005) Caesarean scar pregnancy: a diagnosis to consider carefully in patients with risk factors. Ann Acad Med Singapore 34(2):216–219

    CAS  PubMed  Google Scholar 

  25. Gubbini G, Centini G, Nascetti D, Marra E, Moncini I, Bruni L et al (2011) Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study. J Minim Invasive Gynecol 18(2):234–237

    Article  PubMed  Google Scholar 

  26. Gun M, Mavrogiorgis M (2002) Cervical ectopic pregnancy: a case report and literature review. Ultrasound Obstet Gynecol 19(3):297–301

    Article  CAS  PubMed  Google Scholar 

  27. Farabow WS, Fulton JW, Fletcher V Jr, Velat CA, White JT (1983) Cervical pregnancy treated with methotrexate. N C Med J 44(3):91

    CAS  PubMed  Google Scholar 

  28. Kung FT, Chang SY (1999) Efficacy of methotrexate treatment in viable and nonviable cervical pregnancies. Am J Obstet Gynecol 181(6):1438–1444

    Article  CAS  PubMed  Google Scholar 

  29. Kim TJ, Seong SJ, Lee KJ, Lee JH, Shin JS, Lim KT et al (2004) Clinical outcomes of patients treated for cervical pregnancy with or without methotrexate. J Korean Med Sci 19(6):848–852

    Article  PubMed  PubMed Central  Google Scholar 

  30. Verma U, Maggiorotto F (2007) Conservative management of second-trimester cervical ectopic pregnancy with placenta percreta. Fertil Steril 87(3):697.e13–6

    Article  Google Scholar 

  31. Jeng CJ, Ko ML, Shen J (2007) Transvaginal ultrasound-guided treatment of cervical pregnancy. Obstet Gynecol 109(5):1076–1082

    Article  PubMed  Google Scholar 

  32. Kumar S, Vimala N, Dadhwal V, Mittal S (2004) Heterotopic cervical and intrauterine pregnancy in a spontaneous cycle. Eur J Obstet Gynecol Reprod Biol 112(2):217–220

    Article  PubMed  Google Scholar 

  33. Krissi H, Hiersch L, Stolovitch N, Nitke S, Wiznitzer A, Peled Y (2014) Outcome, complications and future fertility in women treated with uterine artery embolization and methotrexate for non-tubal ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 182:172–176

    Article  PubMed  Google Scholar 

  34. Zakaria MA et al (2011) Conservative management of cervical ectopic pregnancy: utility of uterine artery embolization. Fertil Steril 95(3):872–876

    Article  PubMed  Google Scholar 

  35. Song MJ et al (2009) Serial transvaginal sonographic findings of cervical ectopic pregnancy treated with high-dose methotrexate. J Ultrasound Med 28(1):55–61

    PubMed  Google Scholar 

  36. Piccioni MG et al (2015) Cervical ectopic pregnancy treated with systemic methotrexate and following successful term pregnancy: case report. J Obst Gynaecol 24:1–2

    Google Scholar 

  37. Westendorp AK, Miny P, Holzgreve W, De Wilde R, Aydinli K (1988) Selective fetocide by direct intracardiac injection of isotonic potassium chloride. Arch Gynecol Obstet 244(1):59–62

    Article  CAS  PubMed  Google Scholar 

  38. Shrestha E, Yang Y, Li X, Zhang Y (2011) Successful conservative management with methotrexate and mifepristone of cervical pregnancy. J Biomed Res 25(1):71–73

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Kim JS, Nam KH, Kim TH, Lee HH, Lee KH (2008) Hysteroscopic management of cervical pregnancy with intrauterine irrigation with H2O2. J Minim Invasive Gynecol 15(5):627–630

    Article  PubMed  Google Scholar 

  40. Fylstra DL (2014) Cervical pregnancy: 13 cases treated with suction curettage and balloon tamponade. Am J Obstet Gynecol 210(6):581.e1-5

    Article  PubMed  Google Scholar 

  41. Ash S, Farrell SA (1996) Hysteroscopic resection of a cervical ectopic pregnancy. Fertil Steril 66(5):842–844

    Article  CAS  PubMed  Google Scholar 

  42. Jozwiak EA, Ulug U, Akman MA, Bahceci M (2003) Successful resection of a heterotopic cervical pregnancy resulting from intracytoplasmic sperm injection. Fertil Steril 79(2):428–430

    Article  PubMed  Google Scholar 

  43. Woodforde SJ, Diggory PLC, Edelman PJ (1978) Management of cervical pregnancy with circumsuture and intracervical obturator. Br Med J 1(6116):825

    Google Scholar 

  44. Mashiach S, Admon D, Oelsner G, Paz B, Achiron R, Zalel Y (2002) Cervical Shirodkar cerclage may be the treatment modality of choice for cervical pregnancy. Hum Reprod 17(2):493–496

    Article  PubMed  Google Scholar 

  45. Matracaru G (1968) A new method for the surgical treatment of the cervix pregnancy. Zentralbl Gynakol 90(37):1264–1268

    CAS  PubMed  Google Scholar 

  46. Akutagawa N, Nishikawa A, Saito T, Sagae S, Kudo R (2001) Conservative vaginal surgery for cervical pregnancy. BJOG 108:888–889

    CAS  PubMed  Google Scholar 

  47. Lobel SM, Meyerovitz MF, Benson CC, Goff B, Bengtson JM (1990) Preoperative angiographic uterine artery embolization in the management of cervical pregnancy. Obstet Gynecol 76(5 Pt 2):938–941

    CAS  PubMed  Google Scholar 

  48. Tinelli A, Malvasi A, Vergara D, Casciaro S (2007) Emergency surgical procedure for failed methotrexate treatment of cervical pregnancy: a case report. Eur J Contracept Reprod Health Care 12(4):391–395

    Article  PubMed  Google Scholar 

  49. Choi HS, Kim NY, Ji YI (2015) Laparoscopic uterine artery occlusion before cervical curettage in cervical ectopic pregnancy: safe and effective for preventing massive bleeding. Obstet Gynecol Sci 58(5):431–434

    Article  PubMed  PubMed Central  Google Scholar 

  50. Kung FT, Lin H, Hsu TY, Chang CY, Huang HW, Huang LY et al (2004) Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection. Fertil Steril 81(6):1642–1649

    Article  PubMed  Google Scholar 

  51. Kamoi S, Iwasaki N, Igarashi K, Asakura T, Watanabe M, Ohaki Y et al (2009) Partial trachelectomy: a new and final option for fertility-preserving management of cervical ectopic pregnancy. J Gynecol Surg 25(4):139–146

    Article  Google Scholar 

  52. Treviño-Salinas E, Ayuzo-del Valle C, Guzmán-López A, Dávila-Escamilla I, García-Lezama R, Pérez-Morones D et al (2015) Abdominal trachelectomy for cervical pregnancy: surgical conservative management. J Gynecol Surg 31(1):37–39

    Article  Google Scholar 

  53. Tinelli A, Tinelli R, Malvasi A (2009) Laparoscopic management of cervical-isthmic pregnancy: a proposal method. Fertil Steril 92(2):829.e3–6

    Google Scholar 

  54. Hosni MM, Herath RP, Mumtaz R (2014) Diagnostic and therapeutic dilemmas of cervical ectopic pregnancy. Obstet Gynecol Surv 69(5):261–276

    Article  PubMed  Google Scholar 

  55. Acosta DA (1997) Cervical pregnancy—a forgotten entity in family practice. J Am Board Fam Pract 10(4):290–295

    CAS  PubMed  Google Scholar 

  56. Frates MC, Benson CB, Doubilet PM, Di Salvo DN, Brown DL, Laing FC et al (1994) Cervical ectopic pregnancy: results of conservative treatment. Radiology 191(3):773–775

    Article  CAS  PubMed  Google Scholar 

  57. Malvasi A, Tinelli A, Hudelist G, Tinelli R (2008) Exocervical pregnancy in a patient with intrauterine device: a case report. J Minim Invasive Gynecol 15(6):758–760

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Reproductive Medicine, McGill University, Montréal, QC, Canada

    Togas Tulandi

  2. Department of Obstetrics and Gynecology, McGill University Health Center, Montréal, QC, Canada

    Togas Tulandi

  3. Department of Obstetrics and Gynecology, McGill University, Glen Site, 1001 boulevard Decarie Room D05-2570, Montréal, QC, H4A 3J1, Canada

    Audrey Gilbert MD, FRCSC

  4. Unidad Endoscopia, Centro Gutenberg, Malaga, Spain

    Luis Alonso Pacheco

  5. Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Lecce, Italy

    Andrea Tinelli MD, PhD

  6. Laboratory of Human Physiology, The International Translational Medicine and Biomodelling Research Group, Department of Informatics and Applied Mathematics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia

    Andrea Tinelli MD, PhD

  7. Institute of Physics and Technology (State University), Moscow, Russia

    Andrea Tinelli MD, PhD

  8. Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics & Gynecology, Vito Fazzi Hospital, Lecce, Italy

    Andrea Tinelli MD, PhD

  9. Department of Obstetrics and Gynecology, Santa Maria Hospital, G.V.M. Care and Research, Bari, Italy

    Antonio Malvasi MD

  10. International Translational Medicine and Biomodelling Research Group, Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), Moscow Region, Russia

    Antonio Malvasi MD

Authors
  1. Togas Tulandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Audrey Gilbert MD, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luis Alonso Pacheco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Tinelli MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio Malvasi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Togas Tulandi .

Editor information

Editors and Affiliations

  1. Department of Obstetric and Gynecology, Santa Maria Hospital, Bari, Italy

    Antonio Malvasi

  2. Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Lecce, Italy

    Andrea Tinelli

  3. Department of Obstetrics and Gynaecology, University of Perugia, Perugia, Italy

    Gian Carlo Di Renzo

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Tulandi, T., Gilbert, A., Pacheco, L.A., Tinelli, A., Malvasi, A. (2016). Cervical Pregnancy. In: Malvasi, A., Tinelli, A., Di Renzo, G. (eds) Management and Therapy of Early Pregnancy Complications. Springer, Cham. https://doi.org/10.1007/978-3-319-31377-1_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-31377-1_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31375-7

  • Online ISBN: 978-3-319-31377-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation