I wish to thank Drs Habek and Prka for their comments regarding my article, “Cervical pregnancy: 13 cases treated with suction curettage and balloon tamponade.”

While performing a dilation, evacuation, and curettage to emergently treat a cervical pregnancy (gestational age unknown) they encountered profuse arterial hemorrhage. This bleeding was controlled with suction curettage and cervical packing.

This outcome reinforces my recommendation to do no cervical dilation prior to suction curettage evacuation, and sharp curettage is to be avoided. In my view, the approach by Drs Habek and Prka to not use a cervical infiltration hemostatic agent may have contributed to their patient’s blood loss. Use of this agent can be accomplished quickly and it is a step that I do not recommend be excluded. I can support not placing the cerclage suture because I have never had to tie this during the procedure. Large Foley catheter balloons should be readily available, and I would prefer this for tamponade over a gauze packing because of ease and control of removal. The balloon can be gradually deflated over time in the anticipation of persistent bleeding.