Fertility-Preserving Surgery for Cervical Ectopic Pregnancy, from Past to Present

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, 3], although some surgeons challenged surgical methods to preserve fertility [4-8]. 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, hysterectomy is still considered the final measure. 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 reported in the past.