Cervical pregnancy

Description:

In gynecology it is accepted to allocate distal forms of an extrauterine pregnancy (cervical and peresheechno-cervical) and proximal forms (pipe, belly, ovarian). Cervical and cervical and recervical pregnancy occurs among various options of extrauterine (ectopic) pregnancy quite seldom – in 0,3-0,4% of cases. At truly cervical pregnancy as a fruit bed serves the cervical channel, at peresheechno-cervical localization - area of an isthmus.

Cervical pregnancy poses a threat for the woman's life: as the main danger and a cause of death in 75-85% of cases serves profuse internal bleeding, is more rare – septic complications.

Reasons of cervical pregnancy:

Emergence of cervical pregnancy is connected with difficulty or impossibility of implantation of an oospore in a body of the womb in view of inferiority of an endometria or an insufficient maturity of a trophoblast. Conditions for cervical localization of pregnancy arise owing to the changes of a myometrium caused by the complicated course of the previous childbirth, repeated abortions, diagnostic vyskablivaniye, endometritises, uterus operations, istmiko-cervical insufficiency. It is considered that the risk of cervical pregnancy increases at Asherman's syndrome, a hysteromyoma, carrying out extracorporal fertilization.

Immaturity of a trophoblast in total the factors interfering implantation of fetal egg in a body of the womb can also promote sliding of a blastocyste to the cervical canal.

Trophoblast, and afterwards vorsina of chorion of fetal egg burgeon in a wall of the cervical channel, destroying muscular elements and vessels that is followed by bleeding and disturbance of development of pregnancy. Sometimes, at a full penetration of a wall of a neck of uterus, vorsina of chorion get into a vagina or into a parametrium. Lack of a decidua and protective mechanisms inherent to it leads to the fact that true cervical pregnancy seldom develops longer than 8-12 weeks; cervical and recervical pregnancy can exist is longer – up to 16-24 weeks. In exclusively exceptional cases the distal extrauterine pregnancy is worn to term.

Symptoms of cervical pregnancy:

Expressiveness of clinic of cervical pregnancy depends on the gestational term and level of implantation of a germ.

In typical situations after a delay monthly the woman has bloody allocations from a genital tract. Bleeding has moderate, plentiful or profuse character; sometimes its beginning is preceded by a scanty krovomazaniye. Lack of pain is characteristic of cervical pregnancy.

Existence of well developed network of blood vessels or varicose nodes in a neck of uterus promotes development of sudden bleeding, the hemorrhagic shock and IDCS menacing for life.

Peresheechno-sheechnaya pregnancy, especially in the II trimester, is not followed by so expressed pathognomonic symptoms and quite often forces to think of placental presentation.

Diagnosis:

In the course of diagnosis it is extremely important to differentiate cervical pregnancy from myoma (fibroma) of a uterus, and also spontaneous abortion (abortion in the course). At a fibromyoma of a uterus there are no instructions on pregnancy (a periods delay, positive test for pregnancy). At the come true abortion flaking and lowering of fetal egg to the cervical canal are preceded by colicy pains.

At cervical pregnancy the gynecologic research allows to define existence of barrel-shaped deformation and cyanosis of a neck of uterus, eccentric shift of an outside pharynx, the fetal egg connected with walls of the cervical channel. Size a neck of uterus surpasses the sizes of her body. In attempt of department of fetal egg the tool or a finger note strengthening of bleeding.

Recognition of pregnancy of cervical and recervical localization is difficult in view of absence of explicit clinic and typical data of vulval survey. Periodically renewing bleedings which in process of increase in term of a gestation become more plentiful allow to suspect this option of distal ectopic pregnancy; absence of pains and signs of exile of fetal egg.

As ultrasonic criteria of cervical pregnancy serve hyper echogenicity of an endometria, an intact body of the womb, expansion of the cervical channel containing fetal egg, availability of placental fabric in the cervical channel.

Quite often cervical pregnancy is established only when carrying out a diagnostic scraping concerning an estimated misbirth. In this case difficulties during removal of fetal egg, continuation or strengthening of bleeding after the procedure, the crateriform deepening in a wall of a neck of uterus are noted.

Treatment of cervical pregnancy:

Identification of cervical pregnancy forms the basis for immediate hospitalization of the woman.

Priority is the bleeding stop for what resort to a hard tamponade of a vagina, underrunning of its side arches, imposing of a circular seam on a neck of uterus, to introduction to the cervical channel of a catheter of Foley with inflating of a cuff. As perspective methods at cervical pregnancy serves carrying out embolization of branches of uterine arteries or bandaging of internal ileal arteries that allows then to remove fetal egg without blood.

At inefficiency or impossibility of performance of the listed organ-preserving actions, or intensive bleeding at cervical pregnancy the emergency hysterectomy is shown.

Prevention:

The prevention of development of cervical pregnancy consists in rational treatment of gynecologic diseases, refusal of abortions, carrying out full rehabilitation after intrauterine interventions.

Attentive conducting pregnancy by the obstetrician-gynecologist allows to reveal an ectopic arrangement of fetal egg in early terms of a gestation and not to allow emergence of zhizneugrozhayushchy complications.