Obstet Gynecol Sci.  2015 Sep;58(5):431-434. 10.5468/ogs.2015.58.5.431.

Laparoscopic uterine artery occlusion before cervical curettage in cervical ectopic pregnancy: Safe and effective for preventing massive bleeding

• Choi HS
• Kim NY
• Ji YI

• KMID: 2058472
• DOI: http://doi.org/10.5468/ogs.2015.58.5.431

Abstract

Cervical ectopic pregnancy is associated with high risk for massive bleeding conditions. Cervical ectopic pregnancy can usually be treated by methotrexate injection or surgery. We present 4 cases of cervical ectopic pregnancy that were treated successfully with different uterine-conserving methods. By comparing our experience of 4 cases managed in different ways, we found that laparoscopic uterine artery occlusion before cervical curettage is more effective method for preventing massive bleeding.

Keyword

Ectopic pregnancy; Hemostatic techniques; Laparoscopy; Therapeutic occlusion; Uterine artery embolization

MeSH Terms

Curettage*
Female
Hemorrhage*
Hemostatic Techniques
Laparoscopy
Methotrexate
Pregnancy
Pregnancy, Ectopic*
Therapeutic Occlusion
Uterine Artery Embolization
Uterine Artery*
Methotrexate

Figure

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  Fig. 1 Laparoscopic uterine artery occlusion before cervical curettage.

Reference

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

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

3. Weyerman PC, Verhoeven AT, Alberda AT. Cervical pregnancy after in vitro fertilization and embryo transfer. Am J Obstet Gynecol. 1989; 161:1145–1146.

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

5. Dialani V, Levine D. Ectopic pregnancy: a review. Ultrasound Q. 2004; 20:105–117.

6. Hirakawa M, Tajima T, Yoshimitsu K, Irie H, Ishigami K, Yahata H, et al. Uterine artery embolization along with the administration of methotrexate for cervical ectopic pregnancy: technical and clinical outcomes. AJR Am J Roentgenol. 2009; 192:1601–1607.

7. Nakao Y, Yokoyama M, Iwasaka T. Uterine artery embolization followed by dilation and curettage for cervical pregnancy. Obstet Gynecol. 2008; 111(2 Pt 2):505–507.

8. Zakaria MA, Abdallah ME, Shavell VI, Berman JM, Diamond MP, Kmak DC. Conservative management of cervical ectopic pregnancy: utility of uterine artery embolization. Fertil Steril. 2011; 95:872–876.

9. Davis LB, Lathi RB, Milki AA, Dahan MH. Transvaginal ligation of the cervical branches of the uterine artery and injection of vasopressin in a cervical pregnancy as an initial step to controlling hemorrhage: a case report. J Reprod Med. 2008; 53:365–368.

10. De La Vega GA, Avery C, Nemiroff R, Marchiano D. Treatment of early cervical pregnancy with cerclage, carboprost, curettage, and balloon tamponade. Obstet Gynecol. 2007; 109(2 Pt2):505–507.

11. Trojano G, Colafiglio G, Saliani N, Lanzillotti G, Cicinelli E. Successful management of a cervical twin pregnancy: neoadjuvant systemic methotrexate and prophylactic high cervical cerclage before curettage. Fertil Steril. 2009; 91:935.e17–935.e19.

12. Wang Y, Xu B, Dai S, Zhang Y, Duan Y, Sun C. An efficient conservative treatment modality for cervical pregnancy: angiographic uterine artery embolization followed by immediate curettage. Am J Obstet Gynecol. 2011; 204:31.e1–31.e7.

13. Park KH, Kim JY, Shin JS, Kwon JY, Koo JS, Jeong KA, et al. Treatment outcomes of uterine artery embolization and laparoscopic uterine artery ligation for uterine myoma. Yonsei Med J. 2003; 44:694–702.

14. Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists. ACOG Committee Opinion. Uterine artery embolization. Obstet Gynecol. 2004; 103:403–404.

15. Hald K, Langebrekke A, Klow NE, Noreng HJ, Berge AB, Istre O. Laparoscopic occlusion of uterine vessels for the treatment of symptomatic fibroids: Initial experience and comparison to uterine artery embolization. Am J Obstet Gynecol. 2004; 190:37–43.