ABSTRACT
BACKGROUND: Cervical pregnancy (CP) is a life-threatening condition that represents less than one percent of all ectopic pregnancies. Transvaginal sonography (TVS) is the gold standard for an accurate diagnosis. For hemodinamically stable women the available treatments involve a medical therapy, alone or in combination with interventional measures (hysteroscopy, angiographic embolization or laparoscopic ligation of uterine arteries). MATERIALS AND METHODS: The authors describe a CP unsuccessfully treated with methotrexate (MTX), but resolved with hysteroscopy. CASE REPORT: A nulliparous woman arrived with low abdominal pain without vaginal bleeding at six weeks of amenorrhea. TVS revealed a gestational sac implanted in the isthmic cervical region, with a serum beta-hCG of 1,100 mUI/ml, that raised to 4,274 mUI/ml in a week, despite one intrasaccular-MTX injections and two systemic doses. The authors arranged for a hysteroscopic resection with no previous dilatation of the cervix. They did not adopt any safety precautions to their procedure. CONCLUSION: It is difficult to define the exact role of hysteroscopy regarding CP. Despite some authors dispute on its complementary function to MTX, the authors believe that it could be used as a rescue method in case of MTX failure. The final aims of a proper management are to minimize the risk of haemorrhage and preserve women's fertility.
Subject(s)
Hysteroscopy , Pregnancy, Ectopic/surgery , Abortifacient Agents, Nonsteroidal/administration & dosage , Abortifacient Agents, Nonsteroidal/adverse effects , Adult , Cervix Uteri/surgery , Female , Humans , Methotrexate/administration & dosage , Methotrexate/adverse effects , Pregnancy , Pregnancy, Ectopic/diagnostic imaging , Pregnancy, Ectopic/drug therapy , Treatment Failure , UltrasonographyABSTRACT
BACKGROUND: Myometrial invasion of endometrial carcinoma is an important prognostic factor because the degree of myometrial invasion is correlated with the rate of lymphnode metastases and of recurrences. The aim of the study was a preoperative evaluation of endometrial carcinoma by Magnetic Resonance (MR). METHODS: The authors present a prospective study performed on 54 cases of endometrial carcinoma collected at the Department of Gynecology and Obstetrics of the University of Trieste (Italy). All the patients were considered as Stage I after hysteroscopy and endocervical curettage. Prior to surgery all the patients underwent MR at the Department of Radiology of the University of Trieste (Italy) in order to evaluate the depth of myometrial invasion. The surgical procedure included total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic and lomboaortic lymphadenectomy in high risk cases. Statistical evaluation was performed by Fischer's exact test. RESULTS: Statistically significant positive correlation was found (p<0.001) between MR staging and surgical staging. The sensitivity reported in our series for distinguishing between superficial disease (Stage IA and IB) and deep myometrial invasion (Stage IC) was 92%. CONCLUSIONS: Preoperative MR is helpful in selecting patients at high risk of nodal involvement and it is suggested that, although MR is considered an expensive examination, its use should be always considered before surgical treatment of patients with high surgical risk.
