Cervical pregnancy – option of disteel ektopichesky pregnancy at which implantation and development of fetal egg happens in cervical channel of a uterus. Cervical pregnancy is shown by bleeding of various degree of expressiveness – from moderate allocations to plentiful blood loss. Represents the dangerous state fraught with development of lethal hemorrhagic and septic complications. Diagnostics of cervical pregnancy is performed by means of vaginal and ultrasonography, a diagnostic scraping. At impossibility of performance of organ-preserving actions at cervical pregnancy carrying out an extirpation of a uterus is shown.
In gynecology it is accepted to allocate disteel forms of extra-uterine pregnancy (cervical and peresheechno-cervical) and proximal forms (pipe, belly, yaichnikovy). Cervical and cervical and recervical pregnancy occurs among various options of extra-uterine (ektopichesky) pregnancy quite seldom – in 0,3-0,4% of cases. At truly cervical pregnancy plodovmestilishchy the cervical channel serves, 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 profuzny internal bleeding, is more rare – septic complications.
Reasons of development of cervical pregnancy
Emergence of cervical pregnancy is connected with difficulty or impossibility of implantation of the impregnated ovum in a uterus body in view of inferiority of endometrium or an insufficient maturity of a trofoblast. Conditions for cervical localization of pregnancy arise owing to the changes a miometriya caused by the complicated course of the previous childbirth, repeated abortions, diagnostic vyskablivaniye, endometritises, uterus operations, istmiko-tservikalny insufficiency. It is considered that the risk of cervical pregnancy increases at Asherman's syndrome, uterus myoma, carrying out extracorporal fertilization.
Immaturity of a trofoblast in total the factors interfering implantation of fetal egg in a uterus body can also promote sliding of a blastocyst to the tservikalny canal. , and subsequently vorsina of a horion of fetal egg sprout in a wall of the tservikalny channel, destroying muscular elements and vessels that is followed by bleeding and violation of development of pregnancy. Sometimes, at a full penetration of a wall of a neck of a uterus, vorsina of a horion get into a vagina or into parametry. Lack of a detsidualny cover and protective mechanisms peculiar 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 disteel extra-uterine 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 profuzny character; sometimes its beginning is preceded by a poor krovomazaniye. Lack of pain is characteristic of cervical pregnancy.
Existence of well developed network of blood vessels or varicose knots in a neck of a uterus promotes development of sudden bleeding, the hemorrhagic shock and DVS-syndrome menacing for life. Peresheechno-sheechnaya pregnancy, especially in the II trimester, is not followed by so expressed patognomonichny symptoms and quite often forces to think of prelying of a placenta.
Diagnostics of cervical pregnancy
In the course of diagnostics it is extremely important to differentiate cervical pregnancy from myoma (fibroma) of a uterus, and also spontaneous termination of pregnancy (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 skhvatkoobrazny pains.
At cervical pregnancy the gynecologic research allows to define existence of barrel-shaped deformation and cyanosis of a neck of a uterus, eccentric shift of an external pharynx, the fetal egg connected with walls of the cervical channel. Size a neck of a uterus surpasses the sizes of her body. In attempt of office 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 obvious clinic and typical data of vaginal survey. Periodically renewing bleedings which in process of increase in term of a gestation become more plentiful allow to suspect this option of disteel ektopichesky pregnancy; absence of pains and signs of exile of fetal egg.
As ultrasonic criteria of cervical pregnancy serve the endometrium giperekhogennost, an intact body of a uterus, expansion of the cervical channel containing fetal egg, availability of placentary fabric in the tservikalny channel. Quite often cervical pregnancy is established only when carrying out a diagnostic scraping concerning alleged spontaneous abortion. In this case difficulties during removal of fetal egg, continuation or strengthening of bleeding after the procedure, the crateriform deepening in a uterus neck wall are noted.
Treatment of cervical pregnancy
Identification of cervical pregnancy forms the basis for immediate hospitalization of the woman. A priority is the bleeding stop for what resort to a hard tamponada of a vagina, a proshivaniye of its side arches, imposing of a circular seam on a uterus neck, to introduction to the cervical channel of a catheter of Foley with inflating of a manzhetka.
As perspective methods at cervical pregnancy serves carrying out an embolization of branches of uterine arteries or bandaging of internal podvzdoshny 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 nadvlagalishchny amputation of a uterus, or a subtotal hysterectomy is shown (removal of a uterus with preservation of her neck in a vagina).
Prevention of cervical pregnancy
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 ektopichesky arrangement of fetal egg in early terms of a gestation and not to allow emergence of zhizneugrozhayushchy complications.