w Incidence in the United States: 1:2400 ~ 1:50000 pregnancies.

w Conditions Predisposing to Cervical Pregnancy:

previous therapeutic abortion, Asherman’s syndrome, previous cesarean delivery, diethylstilbestrol exposure, leiomyomata, in vitro fertilization.

　

w Diagnostic Criteria: ( Paalman and McElin )

? Uterine bleeding without cramping pain following a period of amenorrhea.

‚ A soft, enlarged cervix equal to or larger than the fundus

( the “hourglass” uterus )

ƒ Products of conception entirely confined within and firmly attached to the

endocervix

„ A closed internal cervical os.

… A partially opened external os.

w Ultrasonographic Diagnostic Criteria:

? Echo-free uterine cavity or the presence of a false gestational sac only

‚ Decidual transformation of the endometrium with dense echo structure

ƒ Diffuse uterine wall structure

„ Hourglass uterine shape

… Ballooned cervical canal

† Gestational sac in the endocervix

‡ Placental tissue in the cervical canal

ˆ Closed internal os

w Differential Diagnosis:

? Ongoing spontaneous abortion

‚ Cervical Carcinoma

ƒ Cervical or prolapsed submucous leiomyomata

„ Trophoblastic tumor

… Placenta previa

† Low-lying placenta

w Treatment:

Ÿ Non-surgical:

• MTX therapy: intra-amniotic or systemic.
• KCl injection: intra-amniotic.

Ÿ Surgical:

• D&C:

1). Preoperative preparation: blood typing and cross-matching,

establishment of intravenous access, and detailed informed consent.

2). If hemorrhage occurs, the following techniques may be utilized:

¬ Uterine packing

­ Lateral cervical suture placement to ligate the lateral cervical

vessels

® Placement of a cerclage

‾ Insertion of an intracervical 30-ml Foley catheter

° Angiographic artery embolization

± Ligation of the uterine or internal iliac arteries

² Hysterectomy