Classification and Management of Cervical Ectopic Pregnancies Experience at a Single Institution

Abstract

OBJECTIVE: To classify cervical ectopic pregnancies including previous cesarean section scar pregnancies and to describe the management of cervical ectopic pregnancies. STUDY DESIGN: This was a retrospective analysis of all cervical ectopic pregnancies, including previous cesarean scar pregnancies, diagnosed at the Korea University Guro Hospital, Seoul, Korea, between January 1997 and October 2009 using transvaginal ultrasound. Clinical and demographic data were recorded in all cases. The pregnancies were categorized into three groups and subclassified into five types on the basis of transvaginal ultrasound and history of a previous cesarean delivery. The management of cervical pregnancies included medical treatment such as systemic methotrexate (single dose or multiple doses) or intraamniotic methotrexate and surgical treatment such as dilation and curettage (D&C), laparoscopic exploration and hysterectomy. RESULTS: Forty cervical ectopic pregnancies including previous cesarean section scar pregnancies were diagnosed. Cesarean section scar related pregnancy (intramural type and nonintramural type) and cesarean section scar unrelated pregnancy accounted for 10, 12 and 18 cases, respectively. D&C was performed in 21 patients and was successful in all cases except one. The success rate of medical treatment was 61.5% (8/13). Nine patients (22.5%) required a blood transfusion, and a total hysterectomy was performed in five patients (12.5%). CONCLUSION: Cervical ectopic pregnancies were classified, including previous cesarean scar pregnancies, into five types based on the findings of transvaginal ultrasound and history of a previous cesarean delivery. (J Reprod Med 2010;55:469-476)