Cervical pregnancy is a rare form of ectopic pregnancy. The incidence ranges between 1/2500–12,000 pregnancies, which represent approximately 0.15% of all ectopic pregnancies. It is characterized by profuse even life-threatening hemorrhage, which may lead to an emergency hysterectomy. Recently, widespread use of high-resolution ultrasound has enabled the early diagnosis of cervical pregnancy, thereby allowing the application of conservative measures for women who desire to preserve fertility and/or obviate hysterectomy.

Various conservative treatments have been reported previously, including local or systemic administration of methotrexate (MTX), Foley catheter tamponade, curettage and local prostaglandin injection, cervical cerclage and intracervical injections of vasoconstricting agents, laparoscopy-assisted uterine artery ligation combined with hysteroscopic endocervical resection, and angiographic uterine artery embolization (UAE). However, there is no consensus to date about the best approach mainly due to a lack of evidence derived from large series of clinical cases.

We previously reported 2 cases of cervical pregnancy successfully treated by UAE followed by immediate curettage. Recently, 2 groups described their successful experience using a similar procedure in case reports. In our present study, we reported 16 cases of cervical pregnancy that were successfully treated by this conservative modality. We evaluated the efficacy of the method and clinical outcomes with special reference to an efficient solution, quick regression of serum human chorionic gonadotropin (hCG) level and cervical mass, fertility preservation, and a short hospital stay after the treatment.

Materials and Methods

Patients

A total of 20 patients with a confirmed cervical pregnancy were treated in our department from April 2003 through June 2009. All 20 patients wished to preserve fertility and/or obviate hysterectomy. From the original group, 4 patients were successfully treated with MTX-based therapy; 15 patients underwent UAE followed by immediate curettage; and 1 patient underwent UAE only.

Of the 16 patients (mean age, 33.2 years; range, 21–44 years) who underwent UAE, 4 patients were transferred from local hospitals, and the remaining 12 patients were admitted from the outpatient clinic of the department of gynecology or from the emergency department. All of the patients initially presented with abnormal vaginal bleeding; the average bleeding time was 10.5 days (range, 2–23 days) since bleeding started. Four patients initially received MTX-based therapy that ultimately failed. All but 2 patients were multigravidas. Fifteen patients had at least 1 risk factor for cervical pregnancy, such as termination of pregnancy by curettage (11/16), cesarean section (6/16), and intrauterine device (3/16). One patient had a previous myomectomy. All the pregnancies were the results of spontaneous pregnancy except for 1 pregnancy that occurred after in vitro fertilization (IVF). The estimated gestational age ranged from 37–70 days; the average was 53.8 days. The clinical background of the patients is listed in Table 1 .

TABLE 1

Clinical background of patients with cervical pregnancy

Case no.	Patient age, y	Gravida, Para	Risk factors	Gestational age, d	Size of gestational sac, mm	Fetal activity seen on sonography	hCG level, mIU/mL	Status of vaginal bleeding before UAE	Indications for UAE+curettage
1	25	G2, P1	C-S	57	34×32×30	Y	45830	Acute bleeding during MTX treatment	Emergency UAE twice
2	30	G1, P0		55	30×31×28	Y	25600	Acute bleeding after MTX treatment	Emergency
3	39	G3, P1	C-S, myomectomy	40	14×14×10	Y	8395	Non-acute bleeding	Nonemergency
4	21	G1, P0		60	76×66×59 mm heterogeneous mass on cervix	N	1392	Bleeding for 20 days after MTX+mefipristone treatment	Nonemergency
5	30	G4, P1	C-S, IUD	57	23×13×15	Y	NA	Non-acute bleeding	Nonemergency
6	33	G4, P1	C-S	60	19×12×10	Y	32378	Non-acute bleeding	Nonemergency
7	44	G4, P1	IUD	54	35×18×26	Y	56434	Non-acute bleeding	Nonemergency
8	32	G4, P1	C-S	53	28×24×16	Y	30312	Acute massive bleeding during ternination of pregnancy by curretage	Emergency
9	41	G1, P1	IUD	70	36×22×32	N	1536	Persistent bleeding after MTX treatment	Nonemergency
10	38	G2, P0		44	25×12×7	Y	13425	Non-acute bleeding	Nonemergency
11	42	G1, P1	C-S	60	38×36×22	Y	>10000	Non-acute bleeding	Nonemergency
12	29	G1, P0		50	32×23×34	N	252	Acute massive bleeding	Emergency
13	41	G4, P1		48	13×9×10	N	8409	Non-acute bleeding	Nonemergency
14	22	G4, P1		65	46×45×46 mm heterogeneous mass on cervix	N	743	Initially misdiagnosed as inevitable miscarriage, presenting acute bleeding during curretage	Emergency
15	36	G0, P0	IVF	37	14×12×10 mm GS in cervix and 13×15×17 mm GS in uterus cavity	N	17982	Acute bleeding	Emergency
16	28	G0, P0		50	22×18×8	N	9574	Non-acute bleeding	Nonemergency

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