Obstet Gynecol Sci.  2023 Mar;66(2):94-99. 10.5468/ogs.22252.

New paradigm for cervico-isthmic pregnancy: conservative management of cervico-isthmic pregnancy leading to successful deliveries

• Ha J
• Bae JG

• KMID: 2540478
• DOI: http://doi.org/10.5468/ogs.22252

Abstract

Objective
To establish a new treatment option for cervico-isthmic pregnancy (CIP) other than termination by maintaining pregnancy from diagnosis to delivery.
Methods
This retrospective observational study included women diagnosed with CIP at Dongsan Medical Center, Daegu, Korea, from January 2014 to December 2019. Eight patients were diagnosed with CIP using transvaginal ultrasound and met the following inclusion criteria: (1) preserved and closed cervical canal; and (2) more than half of the uterine cavity above the sac was not involved in sac implantation. Five of the eight mothers decided to maintain their pregnancy after an adequate explanation of the possible risks. The same sonographer assessed fetal and maternal status every 1-2 weeks. Intra- and postoperative indicators, delivery information, and neonatal outcomes were also recorded.
Results
The mean patient age was 36 years. In all cases, placenta accreta spectrum and placenta previa were detected using preoperative ultrasonography. A hysterectomy was performed in three cases, and all patients required intensive care unit (ICU) care. The mean operative time was 156 minutes. The rate of postpartum hemorrhage was 40%. Four viable fetuses were delivered. Birth preceding 34 weeks occurred in one patient, who required neonatal ICU hospitalization for 19 days.
Conclusion
Conservative treatment with careful diagnosis, management, and sufficient consultation could be an alternative treatment option in women with CIP, particularly older mothers, those with subfertility, and those who expect to have limited future opportunities for a successful pregnancy. Therefore, CIP should be treated as a separate disease entity.

Keyword

Cesarean section; Ectopic pregnancy; Placenta accreta; Placenta previa; Conservative management

Figure

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  Fig. 1 Diagnosis of cervico-isthmic pregnancy; the cervical canal is preserved and closed, but G-sac implantation on the endometrial line is not clear. G-sac, gestational sac.

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  Fig. 2 By this time, the G-sac extends to the intrauterine cavity. G-sac, gestational sac.

Reference

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