Cervical Pregnancy: A Rare But Dangerous Pathology

Cervical Pregnancy: A Rare But Dangerous Pathology
Cervical Pregnancy: A Rare But Dangerous Pathology

Video: Cervical Pregnancy: A Rare But Dangerous Pathology

Video: Emerging Trends in Reproductive Surgery Series: Surgical Management of Rare Ectopic Pregnancies 2022, November
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Contents Cervical pregnancy: a very rare form of pathology Why is the ovum not attached to the uterus? What happens during a cervical pregnancy? The use of methotrexate in a cervical pregnancy Surgical organ-preserving treatments for a cervical pregnancy Combination treatment option

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Ectopic pregnancies were, are and will be. In addition to the fact that an ectopic pregnancy always leads to the loss of nascent life in the mother's body, it also threatens the mother's life. In addition, this pathology often leads to a violation and complete loss of a woman's reproductive function. That is why the study of the problem of ectopic pregnancy, as well as the search for sparing methods of treatment for this condition, do not lose their relevance.

Cervical pregnancy: a very rare form of pathology

Currently, there is an increase in the incidence of ectopic pregnancy. Among all gynecological diseases, this pathology occurs in 9.5% of cases and is a significant cause in the structure of urgent surgical interventions. Every year, complications of ectopic pregnancy claim women's lives.

In the vast majority of cases of ectopic pregnancy, embryonic growth occurs in the fallopian tube. However, there are other (more rare) forms of this pathology. One of these is cervical pregnancy. With this form, the development of the embryo occurs in the cervical canal. How rare is this? According to various sources, the frequency of pathology is 1 in 9000-12000 pregnancies, that is, approximately 0.1-0.4%.

Why is the ovum not attached to the uterus?

Those women who know that the ectopic development of the embryo is very dangerous often ask questions: “Why does it happen that the fertilized egg does not attach in the uterus? Are there ways to prevent this condition?"

There are several leading causes that can lead to cervical pregnancy. These include:

Damage to the endometrium (inner uterine layer) after repeated abortions and / or curettage of the uterine cavity; Inflammatory process of the endometrium; Long-term previous use of intrauterine devices.

A number of factors are also distinguished that contribute to the attachment of the embryo in an atypical place:

Oncological processes in the submucous layer of the uterus; Cicatricial processes affecting the internal pharynx of the uterus; Cervico-cervical insufficiency. What Happens During Cervical Pregnancy?

Since the attachment of the embryo occurs in the mucous membrane lining the cervical canal, the chorionic villi (future placenta) grow into the entire thickness of the cervix itself. Vessels can even reach the peri-uterine tissue. The progression of pregnancy and the further development of chorionic villi leads to the fact that the cervix becomes thinner. These processes inevitably lead to placental abruption and very severe bleeding.

Thus, maintaining pregnancy and bearing a child with a cervical pregnancy is impossible. It is important not only to terminate the pregnancy, but also to do it as early as possible. Moreover, termination of pregnancy by the usual surgical method is impossible, since this process will be accompanied by very severe blood loss.

The use of methotrexate in cervical pregnancy

Until recently, the only way to treat an ectopic pregnancy was to remove the uterus. Another name for this operation is extirpation of the uterus.

Foreign publications indicate that there are other methods of treating this pathology. One of them is the use of methotrexate in combination with folic acid.Methotrexate is an antimetabolite, meaning it interferes with DNA synthesis, especially in fast-growing cells. Thus, the developing fetus dies under the influence of methotrexate. However, this method of treatment has serious drawbacks and undesirable side reactions, both for systemic and local application.

In our country, according to the instructions for the drug, the use of methotrexate as a treatment for ectopic pregnancy is unacceptable. But this is done very rarely in third-level medical institutions after such a decision is made by the ethical committee and the patient's written consent for this treatment. Its purpose: to prevent the removal of the uterus and to give a chance to become a woman a mother in the future.

Surgical organ-preserving treatments for cervical pregnancy

In a number of foreign clinics, alternative methods of treating cervical pregnancy were used, which were aimed not only at interrupting the gestation process, but also at preserving the uterus. Examples of such operations are: excision of the fetal bed, selective embolization (that is, blockage) of the uterine arteries, cervical tamponade, the imposition of a special suture on the cervix. There are also combination therapy regimens that include the use of both methotrexate and one of the surgical methods.

Combined treatment option

Today, in our country, some clinics use a combined method of treating pregnancy localized in the cervical canal. It includes the use of methotrexate in combination with embolization (blockage) of the vessels supplying the uterus, removal of the embryo, the imposition of a special suture on the cervix, ligation of certain branches of the uterine arteries. This method of treatment allows you to maintain women's health and carry out a healthy full-term baby in the future.

Expert commentaryAza Mukhadinovna Balova, obstetrician-gynecologist

With a cervical pregnancy in a patient, a pregnancy test gives a positive result, the level of the hCG hormone increases, but the embryo cannot be detected in the uterus. With the help of additional examination methods, a diagnosis of cervical pregnancy is made. More recently, the only treatment for cervical pregnancy was the urgent removal of the uterus. But now there are surgical methods of treatment that can preserve women's health.

The patient is urgently hospitalized in a hospital of the 3rd level, and an experienced surgeon with laparoscopic access performs clearing (clamping) of the uterine vessels. Further, the ovum is removed using vacuum aspiration. This procedure is sometimes combined with medication.

Another option for surgical intervention is embolization of the arteries that feed the uterus. This is an intervention in which a puncture is first made in the thigh. Then, medical plastic is inserted through it into the vessels that feed the uterus, blocking the blood flow in them. This blockage has almost no effect on healthy blood vessels. In Russia, this method has been applied relatively recently. Embolization is used instead of clamping the uterine vessels, and the other stages of the operation are the same.

The most effective and less traumatic, in my opinion, is the following treatment regimen: the use of selective embolization of the uterine vessels in combination with the removal of the ovum. The method allows you to maintain women's health.

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