درمان حاملگي سرويكال با حفظ باروري: گزارش دو مورد

Treatment of cervical pregnancy with preserving fertility: report of two cases

زمينه و هدف: سرويكس محل نادر و خطرناكی برای حاملگی نابجاست. وقتی محل چسبندگی جفت پايين‌تر از سوراخ داخل سرويكس باشد، حاملگی سرويكال بايد تلقی كرد. از درمان‌های محافظه‌كارانه استفاده از متوتركسات و كلريدپتاسيم، گلوكز هيپراسمولار و پروستاگلاندين است. همچنين درمان‌های جراحی با حفظ باروری مطرح شده است. هدف از اين مطالعه گزارش دو بيمار با حاملگی سرويكال و درمان محافظه‌كارانه با حفظ باروری بود. معرفی بيمار: بيمار اول با حاملگی شش هفته سرويكال و جنين دارای ضربان قلب معرفی می‌شود كه پس از تجويز دو دوز متوتركسات حاملگی به‌طور كامل از بين رفته است. بيمار دوم با حاملگی هشت هفته سرويكال دارای ضربان قلب به ما مراجعه نمود. سه روز پس از تجويز دو دوز متوتركسات، كورتاژ ناحيه اندوسرويكس انجام و حاملگی ختم شد. نتيجه‌گيری: از روش‌های محافظه‌كارانه برای درمان حاملگی سرويكال در بيمارانی كه تمايل به حفظ قدرت باروری دارند می‌توان استفاده كرد كه با موفقيت بالايی همراه است.

Background: Cervix is a rare and dangerous site for ectopic pregnancy. When the placenta is implanted lower than internal cervical os, it is called “cervical pregnancy”. Known risk factors for cervical pregnancy are previous cesarean section, cigarette smoking, premature transfer of fertilized ovum before having suitable endometrium and pelvic inflammatory disease. In the past, hysterectomy was the usual treatment. Nowadays, with the newer diagnostic and therapeutic managements, cases of cervical pregnancy treated by fertility sparing methods have been reported. Conservative treatments include using methotrexate and KCl, hyperosmolar glucose, and prostaglandins. Also, surgical methods with fertility sparing have been reported. The purpose of this study is introducing two cases of cervical pregnancies treated by fertility sparing. Case presentation: The first patient had six weeks pregnancy with live fetus and detectable fetal heart beat. There was six weeks menstrual retard and βhCG titer was 10.000 UI/ml. Two doses of methotrexate were prescribed and pregnancy terminated successfully. The other patient had eight weeks pregnancy with fetal heart beat. There was eight weeks retardation and βhCG titer was 70379 UI/ml with no gestational sac in sonography in both patients. After prescribing two doses of methotrexate and doing curettage three days after the last dose of methotrexate, pregnancy terminated. The known risk factors for our patients were history of endometrial curettage in one and history of cesarean section in both of them. Conclusion: Conservative method may be considered for the treatment of cervical pregnancy in patients who desire to preserve their fertility. The treatment is associated with high success rates. Methotrexate (MTX) is the most common medicine for resolving ectopic cervical pregnancy, other medications such as KCl, hyperosmolar glucose, RU486 and prostaglandins have also been used with different success rate. Methotrexate may be administered systemic (intramuscular or intravenous) or local (intra-amniotic transfusion or intrauterine).