Successful Transvaginal Aspiration of Cervical Pregnancy aft
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Ectopic pregnancies result from extrauterine implantation of embryos and potentially result in fatal hemorrhage, thus warranting a prompt diagnosis and treatment. The cervix is a highly vascularized area, which is potentially suitable for the implantation of a fertilized ovum. However, it is also extremely vulnerable to heavy bleeding due to its suboptimal hemostatic mechanical capacity and its insusceptibility to respond to uterotonic agents. Most ectopic pregnancies occur in the Fallopian tubes, and less than 1% occur in the lining of the endocervical canal.

Case 1
A primiparous 38-year-old woman with cervical pregnancy induced through IVF-embryo transfer (IVF-ET) received multidose methotrexate (MTX); however, the gestational sac enlarged with an increase in β-human chorionic gonadotropin (hCG) levels, indicating treatment failure. Transvaginal aspiration was hence suggested. On the day of aspiration, the β-hCG level was 20585 mIU/mL, and fetal pole was observed. The gestational sac was undetectable upon sonography a week after aspiration and the β-hCG levels (determined serially) reverted to normalcy 2 months after the procedure.

Case 2
A primiparous 36-year-old woman with cervical pregnancy-induced through IVF-ET (Figure 2) received systemic multidose MTX, which did not exert any therapeutic effects. On the day of aspiration, the β-hCG level was 8061.85 mIU/mL. Two weeks after aspiration, her β-hCG level was undetectable.

Conclusion
The overall rate of ectopic pregnancy continues to rise. Early recognition of the signs and symptoms of ectopic pregnancy is paramount to achieving positive patient outcomes. Ectopic pregnancy remains challenging despite the substantial increase in the number of incidences. Cervical pregnancies are rare but potentially lethal, with an increasing incidence owing to artificial reproductive methods. Thus far, no consensus has been obtained regarding the management of this condition. Results suggest that transvaginal aspiration should be considered an alternative upon failure of systemic MTX treatment or in the presence of contraindications for MTX injection. A prompt diagnosis of cervical pregnancy would guarantee the success of conservative treatment.

Source:https://gynecology-obstetrics.imedpub.com/successful-transvaginal-aspiration-ofcervical-pregnancy-after-failed-methotrexatetreatment-a-case-report.php?aid=26370
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