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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(11): 1014-1020
DOI: 10.1055/s-0042-1757954
Original Article
Obstetrics

Experience of a Tertiary Service in the Treatment of Women with Cervical Pregnancy

Experiência de um serviço terciário no tratamento de mulheres com gravidez ectópica cervical
Karen Hiromi Mori 
1   Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Bárbara Virgínia Tavares 
1   Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Daniela Angerame Yela 
1   Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Luis Francisco Cintra Baccaro 
1   Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Cassia Raquel Teatin Juliato 
1   Universidade Estadual de Campinas, Campinas, SP, Brazil
› Institutsangaben Funding/Acknowledgments The authors would like to thank Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) for the master's scholarship to one of the co-authors of the present study (B.V.T). The study was financed in part by CAPES (finance code 001).
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Abstract

Objective Cervical pregnancy is challenging for the medical community, as it is potentially fatal. The treatment can be medical or surgical; however, there are no protocols that establish the best option for each case. The objective of the present study was to describe the cases of cervical pregnancy admitted to a tertiary university hospital over a period of 18 years.

Methods A retrospective study based on a review of the medical records of all cervical pregnancies admitted to the Women's Hospital at Universidade Estadual de Campinas, Southeastern Brazil, from 2000 to 2018.

Results We identified 13 cases of cervical pregnancy out of a total of 673 ectopic pregnancies; only 1 case was initially treated with surgery because of hemodynamic instability. Of the 12 cases treated conservatively, 7 were treated with single-dose intramuscular methotrexate, 1, with intravenous and intramuscular methotrexate, 1, with intravenous methotrexate, 1, with 2 doses of intramuscular methotrexate, and 2, with intra-amniotic methotrexate. Of these cases, one had a therapeutic failure that required a hysterectomy. Two women received blood transfusions. Four women required cervical tamponade with a Foley catheter balloon for hemostasis. There was no fatal outcome.

Conclusion Cervical pregnancy is a rare and challenging condition from diagnosis to treatment. Conservative treatment was the primary method of therapy used, with satisfactory results. In cases of increased bleeding, cervical curettage was the initial treatment, and it was associated with the use of a cervical balloon for hemostasis.

Resumo

Objetivo A gravidez ectópica cervical é um desafio para a comunidade médica, pois pode ser fatal. O tratamento pode ser clínico ou cirúrgico, mas não existem protocolos que estabeleçam a melhor opção para cada caso. O objetivo deste estudo foi descrever os casos de gravidez ectópica cervical internados em um hospital universitário terciário durante 18 anos.

Métodos Estudo retrospectivo com revisão de prontuários de todas as gestações ectópicas cervicais internadas no Hospital da Mulher da Universidade Estadual de Campinas de 2000 a 2018.

Resultados Foram identificados treze casos de gestação ectópica cervical em um total de 673 gestações ectópicas; apenas 1 caso foi inicialmente tratado com cirurgia por causa de instabilidade hemodinâmica. Dos 12 casos tratados conservadoramente, 7 foram tratados com metotrexato por via intramuscular em dose única, 1, com metotrexato pelas vias intravenosa e intramuscular, 1, com metotrexato por via intravenosa, 1, com 2 doses de metotrexato por via intramuscular, e 2, com metotrexato por via intra-amniótica. Desses casos, um apresentou falha terapêutica, e realizou-se uma histerectomia. Duas mulheres receberam transfusões de sangue. Quatro mulheres necessitaram de tamponamento cervical com cateter balão de Foley para hemostasia. Não houve casos fatais.

Conclusão A gravidez cervical é uma condição rara e desafiadora desde o diagnóstico até o tratamento. O tratamento conservador foi o principal método terapêutico utilizado, com resultados satisfatórios. Nos casos de sangramento aumentado, a curetagem cervical foi o tratamento inicial, e foi associada ao uso de balão cervical para hemostasia.

Keywords

cervical pregnancy - ectopic pregnancy - methotrexate - surgery - treatment

Palavras-chave

gravidez cervical - gravidez ectópica - metotrexato - cirurgia - tratamento


Publikationsverlauf

Eingereicht: 17. September 2021

Angenommen: 10. August 2022

Artikel online veröffentlicht:
29. Dezember 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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