Skip to main content Accessibility help
×
Home
Hostname: page-component-55597f9d44-mzfmx Total loading time: 1.004 Render date: 2022-08-17T17:46:12.113Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue false

Book contents

16 - Ultrasonography of the Cervix

from PART II - INFERTILITY EVALUATION AND TREATMENT

Published online by Cambridge University Press:  04 August 2010

Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
Get access

Summary

INTRODUCTION

Ultrasound is an essential diagnostic tool in gynecologic and obstetric practice and is of special importance for management of infertile patients. With the advancement of ultrasound technology and ultrasound machines and with introduction of 3D technology as well, detailed examination of the uterine cervix, anatomy, and accurate measurements have become possible (1). This has broadened the uses of sonographic examination in infertile patients as well as in pregnancy, mainly due to the importance of uterine cervix examination for prediction of preterm labor (2).

MORPHOLOGY OF THE UTERINE CERVIX

The cervix is the cylindrical portion of the uterus, which enters the vagina and lies at right angles to it. It measures 2–4 cm in length. The point of junction to the uterus is called the isthmus. Branches of the uterine arteries are situated lateral to the cervix and can be seen by color Doppler at transvaginal ultrasound (3).

By transvaginal ultrasound, the cervix is seen in the sagittal plane as a cylindrical, moderately echogenic structure with a central canal (Figure 16.1). The internal os is better identified during pregnancy. The cervical mucus is more prominent during pregnancy, facilitating the recognition of the cervical canal (Figure 16.2). The cervical gland area is an area surrounding the cervical canal, which is either hypo- or hyperechoic; its absence has been related to preterm labor (4–6).

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Sladkevicius, P, Campbell, S. Advanced ultrasound examination in the management of subfertility. Curr Opin Obstet Gynecol 2000;12(3):221–5.CrossRefGoogle ScholarPubMed
Kagan, K, To, M, Tsoi, E, Nicolaides, K. Preterm birth: the value of sonographic measurement of cervical length. BJOG 2006;113(s3):5–56.CrossRefGoogle ScholarPubMed
Di Saia, PJ. Disorders of uterine cervix. In Scott, JR, DiSaia, P, Hammond, CB, et al. (Eds.): Danforth's Obstetrics and Gynecology, 7th ed. Philadephia: JB Lippincott, 1994.Google Scholar
Sekyia, T, Yoshimatsu, K, et al. Detection rate of the cervical gland area during pregnancy by transvaginal sonography in the assessment of cervical maturation. Ultrasound Obstet Gynecol 1998;12:328.CrossRefGoogle Scholar
Yoshimatsu, K, Sekiya, T, Ishihara, K, Fukami, T, Otabe, T, Araki, T. Detection of the cervical gland area in threatened preterm labor using transvaginal sonography in the assessment of cervical maturation and the outcome of pregnancy. Gynecol Obstet Invest 2002;53(3):149–56.CrossRefGoogle ScholarPubMed
Pires, CR, Moron, AF, Mattar, R, Diniz, AL, Andrade, SG, Bussamra, LC. Cervical gland area as an ultrasonographic marker for preterm delivery. Int J Gynaecol Obstet 2006;93(3):214–19.CrossRefGoogle ScholarPubMed
Rizk, B, Steer, C, Tan, SL, Mason, BA. Vaginal versus abdominal ultrasound guided oocyte retrieval in IVF. British Journal of Radiology 1990;63:638.Google Scholar
Steer, C, Rizk, B, Tan, SL, Mason, BA, Campbell, S. Vaginal versus abdominal ultrasound for obtaining uterine artery Doppler flow velocity waveforms. British Journal of Radiology 1990;63:398–9.Google Scholar
Steer, C, Rizk, B, Tan, SL, Mason, BA, Campbell, S. Vaginal color doppler assesment of uterine artery impedance in a subfertile population. British Journal of Radiology 1990;63:638.Google Scholar
Qureshi, IA, Ullah, H, Akram, MH, Ashfaq, S, Nayyar, S. Transvaginal versus transabdominal sonography in the evaluation of pelvic pathology. J Coll Physicians Surg Pak 2004;14(7):390–3.Google ScholarPubMed
To, MS, Skentou, C, Cicero, S, Nicolaides, KH. Cervical assessment at the routine 23-weeks scan: problems with transabdominal sonography. Ultrasound Obstet Gynecol 2000;15(4):292–6.CrossRefGoogle ScholarPubMed
Andersen, HF. Transvaginal and transabdominal ultrasonography of the uterine cervix during pregnancy. J Clin Ultrasound 1991;19(2):77–83.CrossRefGoogle ScholarPubMed
Raungrongmorakot, K, Tanmoun, N, Ruangvutilert, P, Boriboonhirunsarn, D, Tontisirin, P, Butsansee, W. Correlation of uterine cervical length measurement from transabdominal, transperineal and transvaginal ultrasonography. J Med Assoc Thai 2004;87(3):326–32.Google ScholarPubMed
Cicero, S, Skentou, C, Souka, A, To, MS, Nicolaides, KH. Cervical length at 22-24 weeks of gestation: comparison of transvaginal and transperineal-translabial ultrasonography. Ultrasound Obstet Gynecol 2001;17(4):335–40.CrossRefGoogle ScholarPubMed
Kurtzman, JT, Goldsmith, LJ, Gall, SA, Spinnato, JA. Transperineal ultrasonography: a blinded comparison in the assessment of cervical length at midgestation. Am J Obstet Gynecol 1998;179(4):852–7.CrossRefGoogle ScholarPubMed
Ozdemir, I, Demirci, F, Yucel, O. Transperineal versus transvaginal ultrasonographic evaluation of the cervix at each trimester in normal pregnant women. Aust N Z J Obstet Gynaecol 2005;45(3):191–4.CrossRefGoogle ScholarPubMed
Carr, DB, Smith, K, Parsons, L, Chansky, K, Shields, . Ultrasonography for cervical length measurement: agreement between transvaginal and translabial techniques. Obstet Gynecol 2000;96(4):554–8.Google ScholarPubMed
Carlan, Sj, Richmond, LB, O'brien, WF. Randomized trial of endovaginal ultrasound in preterm premature rupture of membranes. Obstet Gynecol 1997;89:458–461.CrossRefGoogle ScholarPubMed
Timor-Tritsch, IR, Yunis, RA. Confirming the safety of transvaginal sonography in patients suspected of placenta previa. Obstet Gynecol 1993;81:742.Google ScholarPubMed
Bajo, J, Moreno-Calvo, FJ, Uguet-de-Resayre, C, Huertas, MA, Mateos, F, Haya, J. Contribution of transvaginal sonography to the evaluation of benign cervical conditions. J Clin Ultrasound 1999;27(2):61–4.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
Mansour, RT, Aboulghar, MA. Optimizing the embryo transfer technique. 2002;17(5):1149–53.Google ScholarPubMed
Wongsawaeng, W. Transvaginal ultrasonography, sonohysterography and hysteroscopy for intrauterine pathology in patients with abnormal uterine bleeding. J Med Assoc Thai. 2005;88 (Suppl. 3):S77–81.Google ScholarPubMed
Leone, FP, Lanzani, C, Ferrazzi, E. Use of strict sonohysterographic methods for preoperative assessment of submucous myomas. Fertil Steril 2003;79(4):998–1002.CrossRefGoogle ScholarPubMed
Grimbizis, GF, Camus, M, Tarlatzis, BC, Bonis, JN, Devroey, P. Clinical implication of uterine malformations and hysteroscopic treatment results. Hum Reprod Update 2001;7(2):161–74.CrossRefGoogle Scholar
Valdes, C, Malini, S, Malikanak, LR. Ultrasound evaluation of female genital tract anomalies: a review of 64 cases. Am J Obstet Gynecol 1984;47:89–93.Google Scholar
Nicolini, U, Bellotti, M, Bonazzi, B, Amberletti, D, Candini, GB. Can ultrasound be used to screen uterine malformations?Fertil Steril 1987;47:89–93.CrossRefGoogle ScholarPubMed
Reuter, KL, Daly, DC, Cohen, SM. Septate versus bicornuate uteri: errors in imaging diagnosis. Radiology 1989;172:749–52.CrossRefGoogle ScholarPubMed
Randoph, JF Jr., Ying, YK, Maier, DB, Schmidt, CL, Riddick, DH, Randolph, JR Jr. Comparison of real time ultrasonography, hysterosalpingopraphy, and laparoscopy/hysteroscopy in the evaluation of uterine abnormalities and tubal patency. Fertil Steril 1986;5:828–32.Google Scholar
Raga, F, Bonilla-Musoles, F, Blanes, J, Osborne, NG. Congenital Mullerian anomalies: diagnostic accuracy of three-dimensional ultrasound. Fertil Steril 1996;65:523–8.CrossRefGoogle ScholarPubMed
Wu, MH, Hsu, CC, Huang, KE. Detection of congenital Mullerian duct anomalies using three-dimensional ultrasound. J Clin Ultrasound 1997;25:487–92.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Airoldi, J, Berghella, V, Sehdev, H, Ludmir, J. Transvaginal ultrasonography of the cervix to predict preterm birth in women with uterine anomalies. Obstet Gynecol 2005;106(3):553–6.CrossRefGoogle ScholarPubMed
Jackson, RA, Gibson, KA, Wu, YW, Croughan, MS. Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol 2004;103(3):551–63.CrossRefGoogle ScholarPubMed
Pinborg, A, Loft, A, Nyboe Andersen, A. Neonatal outcome in a Danish national cohort of 8602 children born after in vitro fertilization or intracytoplasmic sperm injection: the role of twin pregnancy. Acta Obstet Gynecol Scand 2004;83(11):1071–8.CrossRefGoogle ScholarPubMed
Allen, VM, Wilson, RD, Cheung, A. Pregnancy outcomes after assisted reproductive technology. J Obstet Gynaecol Can 2006;28(3):220–50.CrossRefGoogle ScholarPubMed
Matijevic, R, Grgic, O, Vasilj, O. Is sonographic assessment of cervical length better than digital examination in screening for preterm delivery in a low-risk population?Acta Obstet Gynecol Scand 2006;85(11):1342–7.CrossRefGoogle Scholar
Guzman, ER, Walters, C, Ananth, CV, O'Reilly-Green, C, Benito, CW, Palermo, A, Vintzileos, AM. A comparison of sonographic cervical parameters in predicting spontaneous preterm birth in high-risk singleton gestations. Ultrasound Obstet Gynecol 2001;18(3):204–10.CrossRefGoogle ScholarPubMed
Heath, VC, Southall, TR, Souka, AP, Elisseou, A, Nicolaides, KH. Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery. Ultrasound Obstet Gynecol. 1998;12(5):312–17.CrossRefGoogle ScholarPubMed
Leung, TN, Pang, MW, Leung, TY, Poon, CF, Wong, SM, Lau, TK. Cervical length at 18-22 weeks of gestation for prediction of spontaneous preterm delivery in Hong Kong Chinese women. Ultrasound Obstet Gynecol 2005;26(7):713–17.CrossRefGoogle ScholarPubMed
Cook, CM, Ellwood, DA. The cervix as a predictor of preterm delivery in ‘at-risk’ women. Ultrasound Obstet Gynecol 2000;15(2):109–13.CrossRefGoogle ScholarPubMed
Iams, JD, Goldenberg, RL, Meis, PJ, Mercer, BM, Moawad, A, Das, A, Thom, E, McNellis, D, Copper, RL, Johnson, F, Roberts, JM. The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med 1996;334(9):567–72.CrossRefGoogle ScholarPubMed
Kikuchi, A, Kozuma, S, Marumo, G, et al. Local dynamic changes of the cervix associated with incompetent cervix before and after Shirodkar's operation. J Clin Ultrasound 1998;26:371.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
Parulekar, SG, Kiwi, R. Dynamic incompetent cervix uteri: sonographic observations. J Ultrasound Med 1988;7(9):481–5.CrossRefGoogle ScholarPubMed
Rust, OA, Atlas, RO, Kimmel, S, Roberts, WE, Hess, LW. Does the presence of a funnel increase the risk of adverse perinatal outcome in a patient with a short cervix?Am J Obstet Gynecol 2005;192(4):1060–6.CrossRefGoogle Scholar
Vayssiere, C, Favre, R, Audibert, F, Chauvet, MP, Gaucherand, P, Tardif, D, Grange, G, Novoa, A, Descamps, P, Perdu, M, Andrini, E, Janse-Marec, J, Maillard, F, Nisand, I. Cervical length and funneling at 22 and 27 weeks to predict spontaneous birth before 32 weeks in twin pregnancies: a French prospective multicenter study. Am J Obstet Gynecol 2002;187(6):1596–604.CrossRefGoogle ScholarPubMed
Berghella, V, Kuhlman, K, Weiner, S, Texeira, L, Wapner, RJ. Cervical funneling: sonographic criteria predictive of preterm delivery. Ultrasound Obstet Gynecol 1997;10(3):161–6.CrossRefGoogle ScholarPubMed
To, MS, Skentou, C, Liao, AW, Cacho, A, Nicolaides, KH. Cervical length and funneling at 23 weeks of gestation in the prediction of spontaneous early preterm delivery. Ultrasound Obstet Gynecol 2001;18(3):200–3. Comment in: Ultrasound Obstet Gynecol 2001;18(3):195–9.CrossRefGoogle ScholarPubMed
Bergelin, I, Valentin, L. Cervical changes in twin pregnancies observed by transvaginal ultrasound during the latter half of pregnancy: a longitudinal, observational study. Ultrasound Obstet Gynecol 2003;21(6):556–63.CrossRefGoogle ScholarPubMed
Bergelin, I, Valentin, L. Normal cervical changes in parous women during the second half of pregnancy—a prospective, longitudinal ultrasound study. Acta Obstet Gynecol Scand 2002;81(1):31–8.CrossRefGoogle ScholarPubMed
Tsoi, E, Akmal, S, Rane, S, Otigbah, C, Nicolaides, KH. Ultrasound assessment of cervical length in threatened preterm labor. Ultrasound Obstet Gynecol 2003;21(6):552–5.CrossRefGoogle ScholarPubMed
Fuchs, IB, Henrich, W, Osthues, K, Dudenhausen, JW. Sonographic cervical length in singleton pregnancies with intact membranes presenting with threatened preterm labor. Ultrasound Obstet Gynecol 2004;24(5):554–7.CrossRefGoogle ScholarPubMed
Conoscenti, G, Meir, YJ, D'Ottavio, G, Rustico, MA, Pinzano, R, Fischer-Tamaro, L, Stampalija, T, Natale, R, Maso, G, Mandruzzato, G. Does cervical length at 13-15 weeks gestation predict preterm delivery in an unselected population?Ultrasound Obstet Gynecol 2003;21(2):128–34.CrossRefGoogle Scholar
Carvalho, MH, Bittar, RE, Brizot, ML, Maganha, PP, Borges da Fonseca, ES, Zugaib, M. Cervical length at 11-14 weeks and 22-24 weeks gestation evaluated by transvaginal sonography, and gestational age at delivery. Ultrasound Obstet Gynecol 2003;21(2):135–9.CrossRefGoogle Scholar
Coroleu, B, Carreras, O, Veiga, A, Martell, A, Martinez, F, Belil, I, Hereter, L, Barri, PN. Embryo transfer under ultrasound guidance improves pregnancy rates after in-vitro fertilization. Hum Reprod 2000;15(3):616–20.CrossRefGoogle ScholarPubMed
Matorras, R, Urquijo, E, Mendoza, R, Corcostegui, B, Exposito, A, Rodriguez-Escudero, FJ. Ultrasound-guided embryo transfer improves pregnancy rates and increases the frequency of easy transfers. Hum Reprod 2002;17(7):1762–6.CrossRefGoogle ScholarPubMed
Flisser, E, Grifo, JA, Krey, LC, Noyes, N. Transabdominal ultrasound-assisted embryo transfer and pregnancy outcome. Fertil Steril 2006;85(2):353–7.CrossRefGoogle ScholarPubMed
Abou-Setta, AM, Mansour, RT, Al-Inany, HG, Aboulghar, MM, Aboulghar, MA, Serour, GI. Among women undergoing embryo transfer, is the probability of pregnancy and live birth improved with ultrasound guidance over clinical touch alone? A systemic review and meta-analysis of prospective randomized trials. Fertil Steril. 2007;88(2):333–41.CrossRefGoogle ScholarPubMed
Brown, JA, Buckingham, K, Abou-setta, A, Bucket, W. Ultrasound versus clinical touch for catheter guidance during embryo transfer in women (Review). Cochrane Library 2007; (1).Google Scholar
Lorusso, F, Depalo, R, Bettocchi, S, Vacca, M, Vimercati, A, Selvaggi, L. Outcome of in vitro fertilization after transabdominal ultrasound-assisted embryo transfer with a full or empty bladder. Fertil Steril 2005;84(4):1046–8.CrossRefGoogle ScholarPubMed
Sallam, HN, Agameya, AF, Rahman, AF, Ezzeldin, F, Sallam, AN. Ultrasound measurement of the uterocervical angle before embryo transfer: a prospective controlled study. Hum Reprod 2002;17(7):1767–72.CrossRefGoogle ScholarPubMed
Romundstad, LB, Romundstad, PR, Sunde, A, During, V, Skjaerven, R, Vatten, LJ. Increased risk of placenta previa in pregnancies following IVF/ICSI; a comparison of ART and non-ART pregnancies in the same mother. Hum Reprod 2006;21(9):2353–8.CrossRefGoogle ScholarPubMed
Chama, CM, Wanonyi, IK, Usman, JD. From low-lying implantation to placenta praevia: a longitudinal ultrasonic assessment. J Obstet Gynaecol 2004;24(5):516–18.CrossRefGoogle ScholarPubMed
Smith, RS, Lauria, MR, Comstock, CH, Treadwell, MC, Kirk, JS, Lee, W, Bottoms, SF. Transvaginal ultrasonography for all placentas that appear to be low-lying or over the internal cervical os. Ultrasound Obstet Gynecol 1997;9(1):22–4.CrossRefGoogle ScholarPubMed
Ghorab, S. Third-trimester transvaginal ultrasonography in placenta previa: does the shape of the lower placental edge predict clinical outcome?Ultrasound Obstet Gynecol 2001;18(2):103–8.CrossRefGoogle Scholar
Heer, IM, Muller-Egloff, S, Strauss, A. Placenta praevia—comparison of four sonographic modalities. Ultraschall Med 2006;27(4):355–9.CrossRefGoogle ScholarPubMed
Tan, NH, Abu, M, Woo, JL, Tahir, HM. The role of transvaginal sonography in the diagnosis of placenta praevia. Aust N Z J Obstet Gynaecol 1995;35(1):42–5.CrossRefGoogle Scholar
Sunna, E, Ziadeh, S. Transvaginal and transabdominal ultrasound for the diagnosis of placenta praevia. J Obstet Gynecol 1999;19(2):152–4.CrossRefGoogle Scholar
Chen, JM, Zhou, QC, Wang, RR. Value of transvaginal sonography in diagnosis of placenta previa. Hunan Yi Ke Da Xue Xue Bao 2001;26(3):289–90.Google ScholarPubMed
Bhide, A, Prefumo, F, Moore, J, Hollis, B, Thilaganathan, B. Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia. BJOG 2003;110(9):860–4.CrossRefGoogle ScholarPubMed
Dawson, WB, Dumas, MD, Romano, WM et al. Translabial ultrasonography and placenta praevia: does measurement of the os-placenta distance predict outcome?J Ultrasound Med 1996;15:441.CrossRefGoogle ScholarPubMed
Opeheimer, LW, Farine, D, Ritchie, JW, et al. What is a low lying placenta. AM J Obstet Gynecol 1991;165:1036.CrossRefGoogle Scholar
Fung TY, Lau TK. Poor perinatal outcome associated with vasa previa: is it preventable? A report of three cases and review of literature.
Nomiyama, M, Toyota, Y, Kawano, H. Antenatal diagnosis of velamentous umbilical cord insertion and vasa previa with color Doppler imaging. Ultrasound Obstet Gynecol 1998;12:426–9.CrossRefGoogle ScholarPubMed
Pent, D. Vasa previa. Am J Obstet Gynecol 1979;134:151–5.CrossRefGoogle ScholarPubMed
Antoine, C, Youn, BK, Silverman, F, Greco, MA, Alvarez, SP. Sinusoidal fetal heart rate pattern with vasa previa in twin pregnancy. J Reprod Med 1982;27:295–300.Google ScholarPubMed
Codero, DR, Helgott, AW, Landy, HJ, Reik, R, Medina, C, O'sullivan, MJA. Nonhemorrhagic manifestation of vasa previa. A clinicopathologic case. Obstet Gynecol 1993;82:689–701.Google Scholar
Young, M, Yu, N, Barham, K. The role of light and sound technologies in the detection of vasa previa. Reprod Fertil Dev 1991;3:439–51.CrossRefGoogle Scholar
Catanzarite, V, Maida, C, Thomas, W, Mendoza, A, Stanco, L, Piacquadio, KM. Prenatal sonographic diagnosis of vasa previa: ultrasound findings and obstetric outcome in ten cases. Ultrasound Obstet Gynecol 2001;18(2):109–15.CrossRefGoogle ScholarPubMed
Baschat, AA. Ante- and intrapartum diagnosis of vasa praevia in singleton pregnancies by colour coded Doppler sonography. Eur J Obstet Gynecol Reprod Biol 1998;79(1):19–25.CrossRefGoogle ScholarPubMed
Oyelese, Y, Catanzarite, V, Prefumo, F, Lashley, S, Schachter, M, Tovbin, Y, Goldstein, V, Smulian, JC. Vasa previa: the impact of prenatal diagnosis on outcomes. Obstet Gynecol 2004;103(5 Pt 1):937–42.CrossRefGoogle ScholarPubMed
Burton, G, Saunders, DM. Vasa praevia: another cause for concern in in vitro fertilization pregnancies. Aust N Z J Obstet Gynaecol 1988;28(3):180–1.CrossRefGoogle ScholarPubMed
Englert, Y, Imbert, MC, Rosendael, E, Belaisch, J, Segal, L, Feichtinger, W, Wilkin, P, Frydman, R, Leroy, F. Morphological anomalies in the placentae of IVF pregnancies: preliminary report of a multicentric study. Hum Reprod 1987;2(2):155–7.CrossRefGoogle ScholarPubMed
Pyrgiotis, E, Sultan, KM, Neal, GS, Liu, HC, Grifo, JA, Rosenwaks, Z. Ectopic pregnancies after in vitro fertilization and embryo transfer. J Assist Reprod Genet 1994;11(2):79–84.CrossRefGoogle ScholarPubMed
Ginsburg, ES, Frates, MC, Rein, MS, Fox, JH, Hornstein, MD, Friedman, AJ. Early diagnosis and treatment of cervical pregnancy in an in vitro fertilization program. Fertil Steril 1994;61(5):966–9.CrossRefGoogle Scholar
Rizk, B, Brinsden, PR. Embryo migration responsible for ectopic pregnancies, 1990;163(4):1639.Google ScholarPubMed
Aboulghar, M, Rizk, B. Ultrasonography of the Cervix. In: Rizk, B (Ed.) Ultrasonography in reproductive medicine and infertility. Cambridge: United Kingdom, Cambridge University Press, 2009, chapter 12.Google Scholar
Ushakov, FB, Elchalal, U, Aceman, PJ, Schenker, JG, Gembruch, U. Cervical pregnancy: past and future. Obstet Gynecol Surv 1997;52(1):45–59.CrossRefGoogle ScholarPubMed
Kim, TJ, Seong, SJ, Lee, KJ, Lee, JH, Shin, JS, Lim, KT, Chung, HW, Lee, KH, Park, IS, Shim, JU, Park, CT. Clinical outcomes of patients treated for cervical pregnancy with or without methotrexate. J Korean Med Sci 2004;19(6):848–52.CrossRefGoogle ScholarPubMed
Doekhie, BM, Schats, R, Hompes, PG. Cervical pregnancy treated with local methotrexate. Eur J Obstet Gynecol Reprod Biol 2005;122(1):128–30.CrossRefGoogle ScholarPubMed
Sherer, DM, Lysikiewicz, A, Abulafia, O. Viable cervical pregnancy managed with systemic Methotrexate, uterine artery embolization, and local tamponade with inflated Foley catheter balloon. Am J Perinatol 2003;20(5):263–7.CrossRefGoogle ScholarPubMed
Mitra, AG, Harris-Owens, M. Conservative medical management of advanced cervical ectopic pregnancies. Obstet Gynecol Surv 2000;55(6):385–9.CrossRefGoogle ScholarPubMed
Pascual, MA, Ruiz, J, Tresserra, F, Sanuy, C, Grases, PJ, Tur, R, Barri, PN. Cervical ectopic twin pregnancy: diagnosis and conservative treatment: case report. Hum Reprod 2001;16(3):584–6.CrossRefGoogle ScholarPubMed
Hassiakos, D, Bakas, P, Creatsas, G. Cervical pregnancy treated with transvaginal ultrasound-guided intra-amniotic instillation of methotrexate. Arch Gynecol Obstet 2005;271(1):69–72CrossRefGoogle ScholarPubMed
Yildizhan, B. Diagnosis and treatment of early cervical pregnancy: a case report and literature review. Clin Exp Obstet Gynecol 2005;32(4):254–6.Google ScholarPubMed
Kirk, E, Condous, G, Haider, Z, Syed, A, Ojha, K, Bourne, T. The conservative management of cervical ectopic pregnancies. Ultrasound Obstet Gynecol 2006;27(4):430–7.CrossRefGoogle ScholarPubMed
Api, O, Unal, O, Api, M, Ergin, B, Alkan, N, Kars, B, Turan, C. Ultrasonographic appearance of cervical pregnancy following successful treatment with methotrexate. Ultrasound Obstet Gynecol 2006;28:845–7.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×