PREGNANCY, CERVICAL

PREGNANCY, CERVICAL

Cervical pregnancy is a rare and dangerous form of ectopic pregnancy that can be treated surgically or conservatively. It is the rare implantation of a fertilized egg in the endocervical canal and accounts for less than 1% of all ectopic pregnancies.

A lot of women often face obstacles in health care that may result in high-risk pregnancies such as cervical pregnancies. In previous experiences with various healthcare systems, reproductive health services play an important role in monitoring these complicated pregnancy-related diseases. Detailed pregnancy history and physical examination should be done in women who have a high risk for ectopic pregnancies. Cervical pregnancies are also viewed as ectopic pregnancies and should be treated as such. Common risk factors for cervical pregnancies include higher maternal age, previous ectopic pregnancies, previous pelvic or abdominal surgeries or procedures, abortions, tubal ligations or IUD insertions, smoking, endometriosis and the use of fertility drugs.

SYMPTOMS

Painless and profuse vaginal bleeding occurs, along with a soft, disproportionately large cervix and an hourglass-shaped uterus is a primary sign of cervical pregnancy. Inappropriate size of the cervix is found when a physical exam is done.

DIAGNOSIS

Transvaginal ultrasound is an important test to find out cervical pregnancy as early as possible. Findings include an empty uterus in an enlarged, barrel-shaped cervix, a gestational sac within the cervical canal with or without cardiac activity, peritrophoblastic Doppler blood flow to the cervix, and an absent “sliding sign” (the intracervical sac fails to slide along the cervical canal when gentle pressure is applied to the cervix with the vaginal transducer).

TREATMENT

Avoiding serious complications like hemorrhage and hysterectomy needs early diagnosis and treatment. Treatments are based on what is presented. Some medical treatments may be given if the patient is hemodynamically stable.

Intra-amniotic injection of potassium chloride injection may help patients avoid hysterectomy in 80% of cases. Dilation and curettage may be done in some cases. Preoperative uterine artery embolization may also be used in controlling bleeding.

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