Feasibility of direct surgical management for early-stage cervical pregnancy: a multicenter retrospective study

Cervical pregnancy (CP) is a rare ectopic pregnancy associated with life-threatening complications if managed improperly. There is currently no consensus on optimal management, and current evidence is largely limited to case reports. In this study, we retrospectively analyzed the clinical data of 178 patients with CP to evaluate the safety and efficacy of direct surgical treatment versus surgery after pretreatment with UAE or methotrexate (MTX). 178 CP patients from three tertiary hospitals were retrospectively categorized into surgery group (surgery alone), uterine artery embolism (UAE) group (surgery after UAE) and methotrexate (MTX) group (surgery after MTX) based on their treatments. The primary outcome was intraoperative blood loss. Secondary outcomes—including treatment success rate, operative duration, hospital stay length, hospitalization cost, blood transfusion rate, and β-hCG/menstrual recovery—were analyzed to assess the safety and efficacy of each management approach. No significant differences in intraoperative blood loss, success rate, or operative time were found between groups. The surgery group, however, had a shorter hospital stay than the UAE and MTX groups, and lower costs than the UAE group. The average diameter of gestational sac (GS) or mass (OR 2.239, 95% CI 1.38–3.62) was identified as an independent risk factor for intraoperative hemorrhage. Direct surgical management demonstrated favorable safety and efficacy in hemodynamically stable early-stage CP, providing benefits in reducing clinical burden, optimizing healthcare resource utilization, and preserving fertility. Moreover, the diameter of GS was an independent risk factor for hemorrhage, which should be comprehensively considered in choosing the optimal treatment for CP.