Hysteroscopic Resection of a Cervical Ectopic Pregnancy: Case Report
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Abstract
Introduction:
Cervical ectopic pregnancy (CEP) is a rare form of ectopic pregnancy, accounting for less than 1% of all ectopic pregnancies, with an estimated incidence of 1 in 9,000 pregnancies. Historically, the management of CEP has involved hysterectomy due to the high risk of uncontrolled hemorrhage. However, advancements in early diagnosis through high-resolution ultrasound and serum beta-human chorionic gonadotropin (β-hCG) quantification have allowed for the exploration of conservative management approaches aimed at preserving fertility.
Case Presentation: We present the case of a 25-year-old female, with no significant gynecological or obstetric history, who presented to the emergency department with vaginal bleeding. Ultrasound examination revealed a gestational sac located in the endocervical region, without a visible embryo, and β-hCG levels were 4,436 mUI/mL. Medical management with methotrexate was initiated according to a multiple-dose regimen, supplemented with folinic acid, but did not result in adequate resolution. Given the persistent rise in β-hCG levels (8,225 mUI/mL), surgical intervention via hysteroscopy was performed. Under regional anesthesia, hysteroscopic resection of the gestational sac was successfully completed using bipolar energy, achieving effective hemostasis with minimal blood loss (50 mL). The patient had an uneventful recovery and was discharged after 72 hours. Follow-up at three weeks post-procedure showed a decrease in β-hCG to undetectable levels (2.3 mUI/mL).
Conclusion: Hysteroscopic resection is a safe and effective conservative treatment option for cervical ectopic pregnancy, minimizing surgical morbidity, preserving fertility, and avoiding radical interventions. However, this approach requires specialized expertise and careful patient selection. Standardized clinical protocols are needed to optimize outcomes and reduce complications.
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References
I. Bouyer, J., Coste, J., Fernández, H., Pouly, J. L., & Job, S. N. (2002). Sites of ectopic pregnancy: A 10-year population-based study of 1800 cases. Human Reproduction, 17(12),
https://doi.org/10.1093/humrep/17.12.3224
II. Vela, G., & Tulandi, T. (2007). Cervical pregnancy: The importance of early diagnosis and treatment. Journal of Minimally Invasive Gynecology, 14(4), 481–
https://doi.org/10.1016/j.jmig.2007.04.005
III. Plascencia-Moncayo, N., et al. (2008). Embarazo cervical. Tres casos. Ginecología y Obstetricia de México, 76(12), 744–
https://doi.org/10.1016/j.pog.2009.12.009
IV. Montañana, P. P., et al. (2004). Embarazo ectópico cervical. Resolución por histeroscopia a propósito de un caso. Revista Iberoamericana de Reproducción, 21, 201–205.
V. Ranade, V., et al. (1978). Cervical pregnancy. Obstetrics and Gynecology, 51(4), 502–505. https://doi.org/10.1097/00006250-197804000-00024
VI. Muriel Tendetza, M. A., Albán Recalde, J. G., Aguayo Eldredge, C. A., & Trujillo Medina, D. F. (2022). Embarazo ectópico cervical, manejo conservador. Reporte de caso clínico. Mediciencias UTA, 6(1), 11–16
https://doi.org/10.31243/mdc.uta.v6i1.1558.2022
VII. Mesogitis, S., Pilalis, A., Daskalakis, G., et al. (2005). Management of early viable cervical pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology, 112(3),
https://doi.org/10.1111/j.1471-0528.2005.00628.x
VIII. Kirk, E., Condous, G., Haider, Z., et al. (2006). The conservative management of cervical ectopic pregnancies. Ultrasound in Obstetrics & Gynecology, 27(4), 430–437
https://doi.org/10.1002/uog.2693
IX. Bettocchi, S., Nappi, L., Ceci, O., & Selvaggi, L. (2004). Office hysteroscopy. Obstetrics and Gynecology Clinics of North America, 31(3), 641–654. https://doi.org/10.1016/j.ogc.2004.05.007
X. Rojas Ruiz, J. C., & Chacha Vargas, D. A. (2021). Resección histeroscópica de embarazo ectópico cervical posterior a fecundación in vitro. Revista Peruana de Ginecología y Obstetricia, 67(2). https://doi.org/10.31403/rpgo.v67i2324
XI. Salazar López Ortiz, C. G., Mondragón-Alcocer, H. L., Salazar Trujillo, J. C., Vázquez-Alvarado, A. P., & Siu-Moguel, G. J. (2023). Tratamiento histeroscópico conservador del embarazo ectópico cervical. Reporte de casos. Reproducción (México), 14(mayo 5), 1–12.
XII. Alanis-Fuentes, J., Brindis-Rodríguez, A., & Martínez-Arellano, M. (2015). Embarazo ectópico cervical. Tratamiento histeroscópico, presentación de un caso. Ginecología y Obstetricia de México, 83, 302–307.