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Vaginal Hysterectomy for Treatment of Cervical Ectopic Pregnancy

Alammari, Roa, MD; Thibodeau, Renee, MD; Harmanli, Oz, MD

doi: 10.1097/AOG.0000000000001782
Contents: Case Report
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BACKGROUND: Cervical ectopic pregnancy can lead to catastrophic hemorrhage, and may be managed conservatively with intra-amniotic methotrexate (MTX), systemic MTX, or both; surgical evacuation with or without balloon tamponade; and uterine artery embolization. However, some patients require hysterectomy, which has traditionally been performed abdominally.

CASE: A 39-year-old parous woman was diagnosed with cervical ectopic pregnancy at an estimated 7 1/7 weeks of gestation. Her β-hCG level remained at 29,433 milli-international units/mL, and the gestational sac persisted on ultrasonography after first intra-amniotic then multidose systemic MTX treatment. After a review of other fertility-sparing procedures, she chose definitive treatment with hysterectomy because she did not desire future childbearing. She underwent a successful vaginal hysterectomy, a novel approach for this condition.

CONCLUSION: Vaginal hysterectomy can be performed successfully for treatment of cervical ectopic pregnancy in patients who have completed childbearing and for whom conservative treatment has failed.

When conservative modalities fail to treat cervical pregnancy, vaginal hysterectomy may be a minimally invasive alternative to abdominal hysterectomy in women who have completed childbearing.

Departments of Obstetrics and Gynecology, Tufts University School of Medicine, Baystate Medical Center, Springfield, Massachusetts.

Corresponding author: Oz Harmanli, MD, Urogynecology and Pelvic Surgery Baystate Medical Center, Professor of Obstetrics and Gynecology, Tufts University School of Medicine, 759 Chestnut Street, S1680 Springfield, MA 01199; email: oz.harmanli@bhs.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.