Cervical pregnancy: past and future

Cervical pregnancy (CP) is a rare life-threatening form of ectopic pregnancy occurring in 1 of 8628 deliveries. We reviewed 117 cases of CP in the English language literature from 1978 and added three cases from our department. Etiology of CP is still unknown, but there is evidence for its association with cervicouterine instrumentation. The possible role of embryo chromosomal abnormality in the CP etiology is considered. Sonography improved pretreatment diagnosis up to 81.8 percent. Obligatory sonographic criteria of CP include endocervical localization of the gestational sac and trophoblastic invasion. About 60 percent of cervical pregnancies are with a viable fetus. The majority of patients with a cervical pregnancy are women with low parity, thus, the current treatment trend is to preserve their reproductive function. The main problem of conservative treatment is life-threatening hemorrhage after pregnancy evacuation. The use of cervical canal tamponade with a Foley catheter balloon led to reliable hemostasis in 92.3 percent of cases in which this method was used. Early diagnosis of CP allowed for treatment by chemotherapy in 32 cases, with an 81.3 percent success rate. Serial beta-human chorionic gonadotropin levels and transvaginal ultrasound with color Doppler are used to monitor therapy. Another conservative treatment modality is local intrasac KCI injections. Hysterectomy is recommended mostly for second and third trimester cervical pregnancy, or for uncontrolled bleeding.