Review of Predisposing Factors of Cervical Ectopic Pregnancy; an Update
Iranian Journal of Emergency Medicine,
Vol. 10 No. 1 (2023),
30 November 2022
,
Page e17
https://doi.org/10.22037/ijem.v10i1.40580
Abstract
Cervical ectopic pregnancies (CEPs) are rare, comprising less than 1% of ectopic pregnancies. On one hand, the abundant blood supply of the cervix and its incompatibility to keep the pregnancy in progress increases the potential for bleeding following CEP, mortality, complications, and infertility in affected women. CEPs are more difficult to diagnose and get identified at later gestational ages. CEP is one of the rarest forms of ectopic pregnancies and most commonly are a consequence of assisted reproductive technology (ART); while definitive risk factors are not fully known. Possible risk factors include cervical and uterine anomalies, previous curettages or cesarean sections, smoking, tubal factor infertility, or in vitro fertilization (IVF) treatment. Our analysis of literature in 200 patient restricted to retrospective case series , showed that a history of previous C-section, uterine curettage or D&C procedures, and a history of using assisted reproductive technology might be some of the potential risk factors. The increasing application of Hegar dilators was hypothesized as the cause of the rise in CEPs. Dilation and curettage (D&C) might also make the subject vulnerable to CEP development in the future. Previous D&C history could be a potential predisposing factor that is common among CEP patients. In this review, we critically reviewed these potential risk factors. In conclusion, the risk factors of CEP and their effect on fertility are also not studied properly. The rarity of these cases makes it difficult to predict as well if the risk of their recurrence is elevated.
- Cervical Ectopic Pregnancy
- Cervix, Risk Factor
- Ectopic Pregnancy
How to Cite
References
Barnhart K, Van Mello NM, Bourne T, Kirk E, Van Calster B, Bottomley C, et al. Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome. Fertility and sterility. 2011;95(3):857-66.
Shaw J, Dey S, Critchley H, Horne A. Current knowledge of the aetiology of human tubal ectopic pregnancy. Human reproduction update. 2010;16(4):432-44.
Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. Journal of family planning and reproductive health care. 2011;37(4):231-40.
Varma R, Gupta J. Tubal ectopic pregnancy. BMJ Clinical Evidence. 2009;2009.
Bouyer J, Coste J, Fernandez H, Pouly J-L, Job-Spira N. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Human reproduction. 2002;17(12):3224-30.
Chandrasekhar C. Ectopic pregnancy: a pictorial review. Clinical imaging. 2008;32(6):468-73.
Farquhar CM. Ectopic pregnancy. The Lancet. 2005;366(9485):583-91.
Stovall TG, Ling FW, Carson SA, Buster JE. Nonsurgical diagnosis and treatment of tubal pregnancy. Fertility and Sterility. 1990;54(3):537-8.
Dickens B, Faundes A, Cook R. Ectopic pregnancy and emergency care: ethical and legal issues. International Journal of Gynecology & Obstetrics. 2003;82(1):121-6.
Gamzu R, Almog B, Levin Y, Avni A, Jaffa A, Lessing JB, et al. Efficacy of methotrexate treatment in extrauterine pregnancies defined by stable or increasing human chorionic gonadotropin concentrations. Fertility and sterility. 2002;77(4):761-5.
Marion LL, Meeks GR. Ectopic pregnancy: history, incidence, epidemiology, and risk factors. Clinical obstetrics and gynecology. 2012;55(2):376-86.
Valley VT, Mateer JR, Aiman EJ, Tkoma ME, Phelan MB. Serum progesterone and endovaginal sonography by emergency physicians in the evaluation of ectopic pregnancy. Academic emergency medicine. 1998;5(4):309-13.
Ackerman TE, Levi CS, Dashefsky SM, Holt S, Lindsay D. Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 1993;189(1):83-7.
Hasani M, Keramat A, Khosravi A, Oshrieh Z. Prevalence of ectopic pregnancy in Iran: a systematic review and meta-analysis. Iranian Journal of Obstetrics, Gynecology and Infertility. 2016;19(23).
Kirk E, Daemen A, Papageorghiou AT, Bottomley C, Condous G, De Moor B, et al. Why are some ectopic pregnancies characterized as pregnancies of unknown location at the initial transvaginal ultrasound examination? Acta obstetricia et gynecologica Scandinavica. 2008;87(11):1150-4.
Lewis G, editor Saving Mothers' Lives: the continuing benefits for maternal health from the United Kingdom (UK) Confidential Enquires into Maternal Deaths. Seminars in perinatology; 2012: Elsevier.
Al-Turki HA. Trends in ectopic pregnancies in Eastern Saudi Arabia. ISRN Obstetrics and Gynecology. 2013;2013.
Webb EM, Green GE, Scoutt LM. Adnexal mass with pelvic pain. Radiologic Clinics. 2004;42(2):329-48.
Kirk E. Ultrasound in the diagnosis of ectopic pregnancy. Clinical Obstetrics and Gynecology. 2012;55(2):395-401.
Leeman LM, Wendland CL. Cervical ectopic pregnancy: diagnosis with endovaginal ultrasound examination and successful treatment with methotrexate. Archives of Family Medicine. 2000;9(1):72.
Jurkovic D, Mavrelos D. Catch me if you scan: ultrasound diagnosis of ectopic pregnancy. Ultrasound in obstetrics & gynecology. 2007;30(1):1-7.
Lemus JF. Ectopic pregnancy: an update. Current Opinion in Obstetrics and Gynecology. 2000;12(5):369-75.
Odejinmi F, Rizzuto M, Macrae R, Olowu O, Hussain M. Diagnosis and laparoscopic management of 12 consecutive cases of ovarian pregnancy and review of literature. Journal of Minimally Invasive Gynecology. 2009;16(3):354-9.
Gon S, Majumdar B, Ghosal T, Sengupta M. Two cases of primary ectopic ovarian pregnancy. Online Journal of Health and Allied Sciences. 2011;10(1).
Panda S, Darlong LM, Singh S, Borah T. Case report of a primary ovarian pregnancy in a primigravida. Journal of Human Reproductive Sciences. 2009;2(2):90.
Plotti F, Di Giovanni A, Oliva C, Battaglia F, Plotti G. Bilateral ovarian pregnancy after intrauterine insemination and controlled ovarian stimulation. Fertility and Sterility. 2008;90(5):2015. e3-. e5.
Odejinmi F, Sangrithi M, Olowu O. Operative laparoscopy as the mainstay method in management of hemodynamically unstable patients with ectopic pregnancy. Journal of minimally invasive gynecology. 2011;18(2):179-83.
Seow KM, Huang LW, Lin YH, Yan‐Sheng Lin M, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2004;23(3):247-53.
Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstetrics & Gynecology. 2006;107(6):1373-81.
Graesslin O, Dedecker Jr F, Quereux C, Gabriel R. Conservative treatment of ectopic pregnancy in a cesarean scar. Obstetrics & Gynecology. 2005;105(4):869-71.
Jin H, Zhou J, Yu Y, Dong M. Intramural pregnancy: a report of 2 cases. The Journal of Reproductive Medicine. 2004;49(7):569-72.
Shufaro Y, Nadjari M. Implantation of a gestational sac in a cesarean section scar. Fertility and sterility. 2001;75(6):1217.
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. The lancet. 2006;367(9516):1066-74.
Katz DL, Barrett JP, Sanfilippo JS, Badway DM. Combined hysteroscopy and laparoscopy in the treatment of interstitial pregnancy. American journal of obstetrics and gynecology. 2003;188(4):1113-4.
Yildizhan R, Kurdoglu M, Kolusari A, Erten R. Primary omental pregnancy. Saudi Medical Journal. 2008;29(4):606.
Ayinde O, Aimakhu C, Adeyanju O, Omigbodun A. Abdominal pregnancy at the University College Hospital, Ibadan: a ten-year review. African journal of reproductive health. 2005:123-7.
Panayotidis C, Abdel-Fattah M, Leggott M. Rupture of rudimentary uterine horn of a unicornuate uterus at 15 weeks' gestation. Journal of Obstetrics and Gynaecology. 2004;24(3):323-4.
Oki T, Baba Y, Yoshinaga M, Douchi T. Super-selective arterial embolization for uncontrolled bleeding in abdominal pregnancy. Obstetrics & Gynecology. 2008;112(2 Part 2):427-9.
Ludwig M, Kaisi M, Bauer O, Diedrich K. Heterotopic pregnancy in a spontaneous cycle: do not forget about it! European Journal of Obstetrics & Gynecology and Reproductive Biology. 1999;87(1):91-3.
Rojansky N, Schenker JG. Heterotopic pregnancy and assisted reproduction—an update. Journal of assisted reproduction and genetics. 1996;13:594-601.
Sarwat A, Nadia A. Abdominal pregnancy; a diagnostic dilema. 2011.
Condous G, Okaro E, Bourne T. The conservative management of early pregnancy complications: a review of the literature. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2003;22(4):420-30.
Glassner M, Aron E, Eskin B. Ovulation induction with clomiphene and the rise in heterotopic pregnancies. A report of two cases. The Journal of reproductive medicine. 1990;35(2):175-8.
Polak G, Stachowicz N, Morawska D, Kotarski J. Treatment of cervical pregnancy with systemic methotrexate and KCl solution injection into the gestational sac–case report and review of literature. Ginekologia Polska. 2011;82(5).
Sardo ADS, Alviggi C, Zizolfi B, Spinelli M, De Rosa P, De Placido G, et al. Cervico-isthmic pregnancy successfully treated with bipolar resection following methotrexate administration: case report and literature review. Reproductive biomedicine online. 2013;26(1):99-103.
Rubin I. Cervical pregnancy. Surg Gynecol Obstet. 1911;13:625-33.
Oyelese Y, Elliott TB, Asomani N, Hamm R, Napoli L, Lewis KM. Sonography and Magnetic Resonance Imaging in the Diagnosis of Cervico‐Isthmic Pregnancy. Journal of ultrasound in medicine. 2003;22(9):981-3.
Kirk E, Condous G, Haider Z, Syed A, Ojha K, Bourne T. The conservative management of cervical ectopic pregnancies. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2006;27(4):430-7.
Murji A, Garbedian K, Thomas J, Cruickshank B. Conservative management of cervical ectopic pregnancy. Journal of Obstetrics and Gynaecology Canada. 2015;37(11):1016-20.
Shinagawa S, Nagayama M. Cervical pregnancy as a possible sequela of induced abortion. Report of 19 cases. American Journal of Obstetrics and Gynecology. 1969;105(2):282-4.
Surampudi K. A case of cervical ectopic pregnancy: successful therapy with methotrexate. The Journal of Obstetrics and Gynecology of India. 2012;62(Suppl 1):1-3.
Ushakov FB, Elchalal U, Aceman PJ, Schenker JG. Cervical pregnancy: past and future. Obstetrical & gynecological survey. 1997;52(1):45-59.
Vela G, Tulandi T. Cervical pregnancy: the importance of early diagnosis and treatment. Journal of minimally invasive gynecology. 2007;14(4):481-4.
Hung T, Jeng C, Yang Y, Wang K, Lan C. Treatment of cervical pregnancy with methotrexate. International Journal of Gynecology & Obstetrics. 1996;53(3):243-7.
Wolcott HD, Kaunitz AM, Nuss RC, Benrubi GE. Successful pregnancy after previous conservative treatment of an advanced cervical pregnancy. Obstetrics & Gynecology. 1988;71(6 Part 2):1023-5.
Sánchez-Ferrer ML, Machado-Linde F, Pertegal-Ruiz M, García-Sánchez F, Pérez-Carrión A, Capel-Aleman A, et al. Fertility preservation in heterotopic cervical pregnancy: what is the best procedure? Fetal diagnosis and therapy. 2011;30(3):229-33.
Paalman RJ, McElin TW. Cervical pregnancy: review of the literature and presentation of cases. American Journal of Obstetrics and Gynecology. 1959;77(6):1261-70.
Weibel HS, Alserri A, Reinhold C, Tulandi T. Multidose methotrexate treatment of cervical pregnancy. Journal of Obstetrics and Gynaecology Canada. 2012;34(4):359-62.
Jung SE, Byun JY, Lee JM, Choi BG, Hahn ST. Characteristic MR findings of cervical pregnancy. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 2001;13(6):918-22.
Adabi K, Nekuie S, Rezaeei Z, Rahimi-Sharbaf F, Banifatemi S, Salimi S. Conservative management of cervical ectopic pregnancy: systemic methotrexate followed by curettage. Archives of gynecology and obstetrics. 2013;288:687-9.
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