OP09.05: Minimally invasive management of cervical ectopic pregnancies

To evaluate the efficacy and safety of a minimally invasive approach in the treatment of cervical ectopic pregnancy (CEP). A retrospective analysis of all CEP cases at a New York City academic tertiary medical centre from 2010-2023. First-line treatment options included transvaginal ultrasound-guided feticide with intrasac methotrexate (MTX), transcervical balloon catheter insertion, and systemic MTX. Uterine artery embolisation (UAE) was used adjunctively in select cases. Primary outcome examined was successful first-line treatment (defined as complete pregnancy resolution with negative bHCG, not requiring surgical intervention). Secondary outcomes were hemorrhage requiring surgical aspiration (D&C), rate of bHCG decrease one week following treatment, interval to negative bHCG, and interval to complete sonographic resolution. A total of 25 patients were diagnosed with CEP: 12 (48%) had a live CEP and 13 (52%) had a non-live CEP. Mean maternal age was 31.7 ± 1.0 years and mean gestational age at diagnosis was 6.04 ± 0.2 weeks. In those with live CEP, 9 (75%) underwent transvaginal ultrasound-guided feticide: 7 (58.3%) as primary treatment and 2 (16.7%) after MTX failure. The average bHCG decrease in the first week following treatment was 52.1% ±10.3, the median (IQR) interval to negative bHCG was 5.5 (4.0) weeks and the median (IQR) time to complete sonographic resolution was 5.0 (3.8) weeks. Transcervical balloon catheter was the initial intervention in 3 (25%) live CEP cases. All live CEP cases resolved without surgical intervention. In the 13 patients with non-live CEP: 11 (84.6%) had systemic MTX and 2 (15.4%) had transcervical balloon catheters. Uterine artery embolisation was performed concurrently in 3 (27.3%) MTX cases and one MTX case required transcervical balloon and then D&C due to persistent bleeding. Minimally invasive management of live CEP with transvaginal ultrasound-guided feticide or with transcervical balloon catheter resulted in uncomplicated resolution of this high-risk ectopic pregnancy.