••• Chapter 29^ Ectopic Pregnancy^285
❍ What is the advantage of laparoscopy versus laparotomy for treatment of an ectopic pregnancy?
The primary advantages are decreased hospital stay, decreased recovery, and decreased costs (over 20 million
dollars/year if laparoscopy is performed primarily).
❍ What is the most common clinical presentation of cervical pregnancy?
Profuse painless vaginal bleeding.
❍ What is the incidence of cervical pregnancy?
1 /9000.
❍ What is the treatment for hemodynamically stable patients diagnosed with cervical pregnancy?
Systemic methotrexate and transcervical evacuation of the pregnancy after angiographic uterine artery embolization
have been reported as successful methods to treat cervical pregnancy.
❍ What is the treatment of a patient with hemorrhage diagnosed with cervical pregnancy?
Hysterectomy if there is uncontrolled hemorrhage (avoid if possible in cases of desired further childbearing).
Dilation and evacuation with preoperative measures (such as transvaginal ligation of the cervical branches of the
uterine arteries, Shirodkar cerclage, angiographic uterine artery embolization, or intracervical vasopressin injection)
to reduce incidence of severe hemorrhage.
❍ What additional measures can be used to control the profuse bleeding in patient diagnosed with cervical
pregnancy?
- Foley catheter with a 30-mL balloon into the dilated cervix, with the tip extending into the uterine cavity for
24 to 48 hours in combination with a purse string suture around the external cervical os to prevent expulsion of
the balloon. - Placement of hemostatic sutures locally in the cervix.
- Angiographic embolization.
- Bilateral internal iliac artery ligation.
- Bilateral uterine artery ligation.
❍ What is the mode of action of methotrexate?
Methotrexate is a folic acid antagonist. More specifically, it inhibits dihydrofolate reductase preventing the
conversion of dihydrofolate to tetrahydrofolate, which is required for the production of purine nucleotides and the
amino acids serine and methionine. Subsequently, this prevents DNA synthesis in the rapidly proliferating cells
such as the trophoblast.
❍ The original methotrexate treatment regimens included multiple doses of methotrexate and alternate
“rescue” treatments. What was given for “rescue”?
Leucovorin also known as folinic acid.
❍ What short-term side effect can be seen with the dose of methotrexate used for ectopic pregnancy?
Nausea, vomiting, stomatitis, mouth ulcerations, diarrhea, and fatigue have been reported. Thrombocytopenia,
liver abnormalities, and neutropenia are rare.