**7. References**

Arslan, M., Pata, O., Dilek, T. U., Aktas, A., Aban, M., & Dilek, S. (2005). Treatment of viable cesarean scar ectopic pregnancy with suction curettage. *Int J Gynaecol Obstet, 89*(2), 163-166.

There is still no consensus about the most appropriate treatment for ectopic pregnancy. Therefore, large prospective randomized trials are still needed to establish common selection criteria, dosage, and length of follow up of the therapies. Furthermore, to increase the success rate, experiences in invasive ultrasound-guided procedures is indeed crucial for the success of this treatment option, but careful selection of patients and their compliance is also important. In this study, local injection of 50 mg etoposide to treat ectopic pregnancy was evaluated and compared with local injection of methotrexate. In women who desire future pregnancy, these two types of conservative treatment may be an acceptable and promising alternative in the management of ectopic pregnancy. Taken together, a local

The advances in ultrasound equipment and easy access to quantitative β-hCG have made the diagnosis of early ectopic pregnancies possible. The efforts to improve the management of ectopic pregnancy have also stimulated many investigators to design new approaches to treat early ectopic pregnancy. This enables successful application of conservative therapies such as local treatment of chemotherapeutic agents such as etoposide or methotrexate. Not like methotrexate, etoposide is not yet considered as a standard treatment for ectopic pregnancy while there are still no criteria established. As compared to local methotrexate treatment, local etoposide treatment has the advantages of better efficacy to treat patients with higher β-hCG level. With the aid of laparoscopic injection, local treatment of etoposide is considered as a precise localization and the minimally invasive option to the management

Part of the contents and research materials in this chapter were extracted from our previous works in Fertility and Sterility. We are giving full acknowledgment of the original publication of the article. Changes may have been made to this work since it was extended

Arslan, M., Pata, O., Dilek, T. U., Aktas, A., Aban, M., & Dilek, S. (2005). Treatment of viable

cesarean scar ectopic pregnancy with suction curettage. *Int J Gynaecol Obstet, 89*(2),

Table 1. Baseline characteristics of the enrolled women

**5. Summary** 

of ectopic pregnancy.

**7. References** 

**6. Acknowledgement** 

163-166.

and re-edited to a book-length form.

injection of etoposide might be a good choice for ectopic pregnancy.


**14** 

*Japan* 

**Fertility-Preserving Surgery for Cervical** 

**Ectopic Pregnancy, from Past to Present** 

*Department of Obstetetrics and Gynecology, Nippon Medical School, Tokyo,* 

Cervical pregnancy is a rare form of ectopic pregnancy in which implantation occurs in the cervical mucosa below the level of the internal os of the uterus. In the past, especially when diagnostic tools like ultrasonography or MRI were unavailable, many patients frequently encountered life-threatening, uncontrollable hemorrhage either spontaneously or when the implant was evacuated by curettage with a presumptive diagnosis of incomplete or inevitable abortion[1]. Hysterectomy was the only measure that could save those patients [2,

Many successful cases of fertility preservation have been reported since anti-chorionic villi drugs like methotrexate (MTX) became available and interventional radiology techniques were improved to reduce hemorrhage during curettage or evacuation. However,

This chapter first describes the history of cervical ectopic pregnancy, followed by the history of its treatment in the past. Then, we present our novel fertility-preserving surgical technique in addition to a review of the uterine-conservation techniques which have been

According to Thomsen and Johansen, the first case of cervical pregnancy was reported in 1817 by Sir Everard Home, who found an early ovum in the cervical canal during postmortem examination. Thereafter, more and more cases were reported soon after Karl Freiherr von Rokitansky described two cases in 1860 in the German literature. The maternal mortality rate early in the 1900s was exceptionally high mainly due to hemorrhage and sepsis (66% according to Hofsatter; 43% according to Zangemeister and Schilling; 13%

However, this rate is not considered to have actually been this high, because of the limited ability of exact diagnosis in those days. That is, patients underwent evacuation of the uterus based on incorrect diagnosis, consequently suffering from massive hemorrhage, which was treated by hysterectomy. In 1946, Schneider defined "distal ectopic pregnancy" as a pregnancy in which the fetus resides in the cervical canal. He classified it into three categories by implantation site: (1) 'pure' cervical ectopic pregnancy; (2) isthmico-cervical pregnancy; and (3) endometrio-isthmico-cervical pregnancy[10]. With the probable

3], although some surgeons challenged surgical methods to preserve fertility [4-8].

hysterectomy is still considered the final measure.

**2. Historical review of cervical ectopic pregnancy** 

according to Concetti), and was estimated to be an average of 30%[9].

**1. Introduction** 

reported in the past.

Seiryu Kamoi, Nao Iwasaki and Toshiyuki Takeshita

