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SBA Questions
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
A diagnosis of a cervical pregnancy has been made in a 36-year-old woman who had two previous normal deliveries. Serum β-hCG has been quantified to help plan for her management. At what β-hCG level will there be a decreased chance of successful treatment with methotrexate?Greater than 5000 IU/LGreater than 7500 IU/LGreater than 8000 IU/LGreater than 9000 IU/LGreater than 10000 IU/L
Cesarean Section Scar Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Two types of CSEP have been proposed: CSEP with progression to the cervicoisthmic space or uterine cavity (type I, endogenic type) and CSEP with deep invasion of a scar defect with progression toward the bladder and abdominal cavity (type II, exogenic type). The endogenic type of CSEP could result in a viable pregnancy but with a high risk of bleeding at the placental site. The exogenic type could be complicated with uterine rupture and bleeding early in pregnancy. All women with a positive pregnancy test and a prior cesarean delivery should undergo an assessment early in pregnancy using TVS, and this imaging modality is the one most likely to identify a CSEP. The differential diagnosis includes cervical pregnancy and an aborting intrauterine pregnancy. Diagnosis of CSEP is based on the following TVS criteria [11–13]: An empty uterine cavity with a clearly demonstrated endometrium and empty cervical canalThe presence of a gestational sac, with or without fetal cardiac activity, embedded and surrounded by the myometrium, in the anterior part of the uterine isthmusA thin (1–3 mm) or absent myometrial layer between the gestational sac and the bladder4 peritrophoblastic flow surrounding the CSEP appearing on Doppler flow sonographyNegative “sliding sign” (inability to displace the gestational sac from its position using gentle pressure with a transvaginal probe)
Clinical analysis of high-intensity focused ultrasound (HIFU) combined with hysteroscopy-guided suction curettage (HGSC) in patients with cervical pregnancy
Published in International Journal of Hyperthermia, 2022
Yufu Huang, Xiaogang Zhu, Luying Wang, Mingzhu Ye, Min Xue, Xinliang Deng, Xin Sun
Cervical pregnancy is an ectopic pregnancy that a gestational sac and fertilized egg implant in the endocervical canal [1,2]. It is a scarce condition with an incidence of 1/8600–1/12400 ectopic pregnancies [3,4]. The causes of cervical pregnancy remain elusive. It has been associated with both a history of the previous curettage and cesarean delivery and fibroids [5]. The use of assisted reproductive technologies has also been considered a risk factor for cervical pregnancies [6]. As most of the cervical tissue is made up of fibrillar connective tissue, when a patient with a cervical pregnancy has an incomplete abortion or undergoes a curettage, a hysterectomy may be required to save the patient’s life because of the heavy bleeding that may occur. It also has an adverse effect on future pregnancies. Therefore, an early diagnosis and proper treatment are important for patients with cervical pregnancy. To reduce bleeding and preserve fertility, pretreatments that can reduce embryonic cardiac activity and vaginal bleeding before suction curettage are conducive. The commonly used preoperative treatment include methotrexate (MTX) and B-scan ultrasonography (USG)-guided injection of MTX and potassium chloride, uterine artery embolization (UAE), and high-intensity focused ultrasound (HIFU).
The treatment of cervical pregnancy with high-intensity focused ultrasound followed by suction curettage: report of three cases
Published in International Journal of Hyperthermia, 2019
Cervical pregnancy (CP) is the implantation of a developing conceptus in the cervical glands and the fibrous cervical wall. The incidence of CP was 1:16,000–1:18,000 in all pregnancies and 1:1000 in all ectopic pregnancies [1]. It is a rare type of ectopic pregnancy and considered to be a life-threatening condition due to the risk of severe bleeding. Previously, treatment of CP often required a hysterectomy to save the patient’s life. In recent decades, it is diagnosed early by transvaginal ultrasound in patients in their first trimester of pregnancy and could be conservatively treated to preserve the uterus. The general principles in the management of cervical pregnancy are as follows: (1) minimize the risk of hemorrhage; (2) eliminate the gestational cervical product; (3) spare fertility [2]. Various conservative methods for cervical pregnancy termination have been suggested in an attempt to preserve the uterus and the patient’s future fertility and to avoid hemorrhage [1,3,4]. Unfortunately, no consensus on standard conservative treatment for CP has been established [5]. Since cervical pregnancy is even more unusual than before, case reports concerned with the conservative management of cervical pregnancy are increasingly important. Below, we report three cases of CP in which high-intensity focused ultrasound (HIFU) was performed as a prophylactic procedure before suction curettage.