Cervical pregnancy

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Cervical pregnancy

  1. 1. A Case of Cervical Pregnancy Frank O’Keeffe AGTS Meeting, Tasmania 2011
  2. 2. Cervical Pregnancy 27 year old Para 1 Delivered by Emerg Caesarian Section at term Obstructed labour 2008 1 miscarriage at 9 weeks…D&C 2009 Fit and well Trying for pregnancy Positive preg test, unsure dates ….Dating scan
  3. 3. Dating scan
  4. 4. Cervical ectopic pregnancy
  5. 5. Cervical Ectopic Pregnancy Rare, < 1% of all ectopics ?more common ART IVF ?3% Assoc with prev surgery/ curettes SIGN Hour glass uterus, GS below UA  Discrete sac doesn’t move ? FH Dx U/Soundimpression 88% correct
  6. 6. Differential Dx Caesar scar Ectopic  Above UA  Anterior wall Incomplete Miscarriage Moves, Less discrete sac Other products /Clot in uterus Ext os open?MRI
  7. 7.  Manage conservatively with MTX Wants more children ? Avoid disaster Local experience and tertiary advice indicate high chance of morbidity & possible hysterectomy Pt aware of risks and consents to Rx
  8. 8. What to Do??? Manage as tubal ectopic / no literature for Cx preg Surgical Past Caesar ? Wound ectopic ? Incomplete M/carriage ? Risk profile Local experience Tertiary Opinion
  9. 9. Follow up Need compliant patient Serial bhCG Pt to present if significant bleeding /Cramping pain
  10. 10. MTX Protocols Single Dose Multidose hCG 50mg/m2  1mg /kg IM bhCG +folinic acid 0.1mg/kg oral Day 4 hCG Day 7 hCG  Day 3,5,7 bhCG if < 15% drop rpt dose If <15% drop Repeat dose  Up to 5 doses
  11. 11. Cervical ectopic BUT bhCG rises and continues to rise Fetal heart activity Enlarging sac Min Loss Cx expanding……………….WHAT TO DO!!!!!
  12. 12. Ultrasound
  13. 13. CD serial scan
  14. 14. Cervical Pregnancy Gyn Onc Consult GOG Protocol Trophoblastic Disease MTX 50mg /m2 weekly / folinic acid Twice weekly bhCG
  15. 15. Cervical pregnancy Pt not happy wants curette Bh CG begins to fall Fetal heart stops Gradual resolution over 10 weeks bhCG 0 at 16 weeks post Dx Sac resorption
  16. 16. Serial Scan
  17. 17. Serial Scan
  18. 18. Cervical Pregnancy Wants more children How to counsel ? Risks Possible complications of cx pregnancy  C/Section  Curette  Cx ectopic  ? Cx incompetence  ? Recurrence
  19. 19. Pregnant Again 6Mo Later Early Scan (s) Cervical length Cx 46mm at 20w Normal pregnancy Planned Rpt Elective C/Section 38-39 weeks
  20. 20. Result Delivers baby boy 5720 g !!!!!! Uncomplicated post op Planning another!!!!!!!
  21. 21. Thank YouEnjoy North West Tassie

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