Cervical pregnancy is the gestational period during which the implantation of the fetal egg and its further development is carried out in the cervical canal of the uterus. Cervical pregnancy refers to the forms of distal ectopic pregnancy. The symptomatology of the development of the abnormal process consists in bleeding of varying severity: from scanty, smearing secretions to copious. Ultrasound examination and gynecological examination are used to diagnose cervical pregnancy. When visualizing ectopic cervical pregnancy, uterine extirpation is indicated.
The content of the article:
Causes of cervical pregnancy
Symptoms of cervical pregnancy
Diagnosis of cervical pregnancy
Treatment of cervical pregnancy
Prevention of cervical pregnancy
Cervical pregnancy
In gynecology, distal and proximal forms of ectopic cervical pregnancy are distinguished. The distal type of gestation includes cervical and isthmic-cervical pregnancy, the proximal — tubal, abdominal, ovarian. Forms of ectopic pregnancy of the cervical and isthmic-cervical type are quite rare in modern gynecology. Cervical pregnancy involves the attachment of the fetal egg in the cervical canal. In the isthmic-cervical form of gestation, implantation occurs in the isthmus zone.
The development of cervical pregnancy entails a high risk of irreversible consequences for a woman, up to a fatal outcome. Internal bleeding and septic lesion are the main danger to life in cervical ectopic pregnancy.
Causes of cervical pregnancy
The main reason for the appearance of cervical pregnancy is the defective state of the endometrium, as well as the immaturity of the trophoblast. These factors cause the impossibility of attaching a fertilized egg in the body of the uterus. In addition, the altered myometrium serves for the further development of cervical pregnancy. Transformed myometrial tissues occur due to such reasons as:
difficult childbirth with injuries and ruptures of the vagina, vulva, perineum;
surgical abortions;
gynecological curettage;
endometritis;
isthmic-cervical insufficiency;
uterine fibroids;
Ascherman syndrome;
carrying out IVF.
Trophoblastic immaturity promotes the penetration of the blastocyst into the cervical canal, as a result of which the fetal egg is unable to attach to the body of the uterus.
Cervical pregnancy can develop up to 8-12 weeks, isthmic-cervical pregnancy — up to 16-24 weeks. In rare cases, the distal ectopic form of gestation may develop before the end of the prescribed period.
Symptoms of cervical pregnancy
Clinical signs of cervical pregnancy depend on the duration of pregnancy and the level of implantation of the fetal egg.
Symptoms of cervical pregnancy occur after a delay in menstruation and manifest themselves in the form of bloody discharge. Their character can be meager, smearing and even up to intense bleeding from the genital tract. There is no pain syndrome in cervical pregnancy.
Mature meshes of blood vessels and varicose nodes of the cervical zone cause the appearance of unexpected bleeding, DIC syndrome, hemorrhagic shock. These clinical signs are life-threatening for a woman.
With isthmic-cervical pregnancy, there is no pronounced symptoms. In the second trimester, it is often deferncated as placenta previa, which is not the case in reality.
Diagnosis of cervical pregnancy
During diagnostic studies, it is necessary to differentiate cervical pregnancy from other pathologies:
fibroids;
uterine fibromyoma;
miscarriage.
Uterine fibroids (fibromyoma) are characterized by the absence of a positive pregnancy test and are not characterized by a delay in menstruation. With spontaneous abortion, pain syndrome of the lower abdomen and sacral zone appears, and there are also cramping pains.
To diagnose cervical intrauterine pregnancy, a gynecological examination is performed, thanks to which cyanosis of the cervix, displacement of the external pharynx and fetal egg to the walls of the cervical canal are detected. The size of the cervix is enlarged and exceeds the volume of the uterus body. During instrumental separation and palpation of the fetal egg, bleeding is noted.
Cervical pregnancy, ultrasound allows you to determine the expansion of the cervical canal, inside which the fetal egg is differentiated, is very clearly distinguishable during this examination. Also, during the ultrasound examination, the presence of placental tissue of the cervical canal, hyperechogenicity of the endometrium are detected.
In frequent cases, the diagnosis of cervical pregnancy is carried out during the operation to scrape the uterus. This surgical intervention is performed according to clinical indications indicating spontaneous abortion. During the operation, the removal of the fetal egg is difficult, there is bleeding during curettage and after the operation; a crater-like depression in the uterine wall is diagnosed.
In the isthmic-cervical form of ectopic pregnancy, there are no clinical signs during vaginal diagnosis. This type of distal pregnancy can be assumed by observing bloody discharge from the vagina. With an increase in gestational age, bleeding is abundant, there is no pain.
Treatment of cervical pregnancy
Initially, after diagnosis and detection of cervical pregnancy, the woman is urgently hospitalized. Further treatment consists in stopping the bleeding. To do this, use a tight tamponade of the vagina, which is sewn on the sides. A circular suture is also applied to the cervix area, a Foley catheter is inserted into the cervical canal. During the treatment of cervical pregnancy, embolization of the branching arteries of the uterus is also used, as well as the internal iliac arteries are bandaged. Such methods allow you to remove the fetal egg.
In individual cases, extirpation of the uterus is performed. This method of treatment is carried out in individual clinical cases when it is impossible to stop bleeding and preserve organs. Extirpation of the uterus is indicated in the absence of positive dynamics after surgical manipulations.
Prevention of cervical pregnancy
To prevent cervical pregnancy, women need to carefully monitor themselves and the health of the reproductive system of the body. To do this, it is worth taking preventive measures:
proper use of contraception;
avoiding unwanted pregnancies and abortions;
timely treatment of gynecological diseases;
keeping records of the menstrual cycle so that pathology can be differentiated at an early stage;
during intrauterine operations, it is necessary to perform full-fledged rehabilitation, including adhering to sexual rest.
It is also necessary to conduct pregnancy with a qualified and experienced gynecologist in order to recognize and prevent the severe consequences of the cervical pregnancy process in time. If you follow all of the above methods, the risk of the disease is reduced to almost zero.
