Abstract
Background: Cervical pregnancy is a rare life-threatening form of ectopic pregnancy and when it occurs, it is challenging to decide the management options. Surgical intervention has been documented to be complicated by intractable haemorrhage and most often necessitating hysterectomy. We hereby report a case of cervical pregnancy managed conservatively with medical agents prior to surgical intervention.
Case presentation and management: A 29 year old primiparous woman with gestational diabetes mellitus who presented at 10 weeks gestation with 5 days history of brownish vaginal discharge and 2 days history of painless vaginal bleeding. On pelvic examination the cervix was disproportionately larger than the uterus with a closed internal os. Transvaginal and abdominal ultrasound scanning confirmed a live cervical pregnancy. She had intramuscular methotrexate and tranexamic acid followed by suction evacuation combined with balloon tamponade. Examination at 6 weeks post procedure revealed a normal cervix.
Conclusion: Cervical pregnancy still occurs in this environment despite its rarity. Surgical intervention usually results in hysterectomy and adopting medical management as a first line treatment option offers the benefit of uterine preservation
Keywords: - cervical pregnancy, methotrexate, ectopic pregnancy, suction evacuation, haemorrhage, conservative management.
Résumé
Contexte: La grossesse cervicale est une rare forme mortelle de grossesse ectopique et quand elle survient, il est difficile de décider les options de gestion. L’intervention chirurgicale a été documentée pour être compliquée par une hémorragie intraitable et le plus souvent nécessitant une hystérectomie. Nous reportons ici un cas de grossesse cervical géré de manière conservative avec des agents médicaux antérieurement à l’intervention chirurgicale.Présentation de cas et de gestion: une femme primipare âgée de 29 ans atteinte du diabète de mellite gestationnel qui s’est présentées à 10 semaines de gestation avec un histoire de 5 jours d’écoulement vaginal brun et un histoire de deux jours de saignement vaginal sans douleur . Sur examen pelvien, le col de
l’utérus était de manière disproportionnée plus grand que l’utérus avec un orifice interne fermé. L’échographie transe-vaginale et abdominale a confirmé une vive grossesse cervicale. Elle avait par voie intramusculaire le méthotrexate et l’acide tranexamique suivie d’évacuation par aspiration aménagée avec un ballon tamponnade. L’examen à 6 semaines après la procédure a révélé un col normal.
Conclusion: La grossesse col de l’utérus survient encore dans cet environnement en dépit de sa rareté. L’intervention chirurgicale résulte généralement en hystérectomie et l’adoption de la gestion médicale comme une première option de traitement de ligne offre l’avantage de la préservation de l’utérus.
Mots-clés: - grossesse cervicale, méthotrexate, la grossesse ectopique, évacuation par aspiration, hémorragie, gestion conservative.
Correspondence: Dr. O.O. Ogunbode, Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Nigeria. E-mail: yinkaogunbode@yahoo.co.uk
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