ajog.
org
because it would be difficult to insert a needle into the tubal
cavity, aspirate the hydrosalpinx, and infuse the sclerosing agent.
Major complications of sclerotherapy reported by others,
all uncommon, are hemorrhage from the vaginal wall, the
oviduct, or other pelvic vessels; trauma related to pelvic
structures such as bowel or ureters; and pelvic infection and
adhesion.2 In our study, we assessed complications by both
patient self-report and clinician assessment, and only mild
abdominal cramping was reported. Na et al1 also found no
suspected intraperitoneal adhesion after sclerotherapy.
It should be mentioned that all the patients in our previous
2010 study3 were enrolled in this study for recruiting more
subjects to further evaluate the efficacy, safety, and recurrence
of hydrosalpinx sclerotherapy. - 3. Jiang H, Pei H, Zhang WX, Wang XM. A prospective clinical study of
Hong Jiang, MD, PhD
Wen-Xiang Zhang, MD
Reproductive Medicine Centre
105th Hospital of PLA
424 West Changjiang Rd.
Preservational procedure of cervical pregnancy
TO THE EDITORS: We read with great interest the article by
Fylstra1 presenting a retrospective series of 13 cases of preop-
eratively ultrasound-confirmed cervical pregnancies in the first
trimester successfully treated by the author’s surgical technique
based on suction curettage and balloon tamponade.
We bring to your attention our case of unrecognized cer-
vical pregnancy in the first trimester2 treated in a way similar
to that reported by Fylstra.1 After gynecologic and ultrasound
examination performed under the differential diagnosis of
current abortion or spontaneous abortion residua in a 30-
year-old woman, G3 P2, with normal obstetric history, we
decided to perform dilatation, evacuation, and curettage.
However, profuse arterial hemorrhage and clinical picture of
obstetric hemorrhagic shock developed during hysterometry
and cervical dilatation. As cervical pregnancy was suspected,
treatment was continued with suction curettage and cervi-
covaginal tamponade with a povidone-soaked strip of gauze
as urgent procedures, which turned out to be definitive
management.
Appreciating the successful preservation surgery technique
described by Fylstra,1 we take this opportunity to note that a
considerably simpler surgical procedure (without the use of
local hemostatic vasoconstrictive agent and placement of an
untied cervical suture, using McDonald cerclage technique)
can prove efficient in unrecognized and emergency conditions
such as the one described above. Moreover, a combination of
suction evacuation and balloon tamponade has proved to be
an appropriate therapeutic option even in case of cervical
pregnancy complicated by cervical perforation.3
On the other hand, our case confirms the statement of Fyl-
stra1 that on suction curettage, cervical dilatation should not be
attempted prior to the insertion of an appropriately sized
Letters to the Editors
Hefei
230031 Anhui, China
jiangh105@sina.com
The authors report no conflict of interest.
REFERENCES
1. Na ED, Cha DH, Cho JH, Kim MK. Comparison of IVF-ET outcomes in
patients with hydrosalpinx pretreated with either sclerotherapy or lapa-
roscopic salpingectomy. Clin Exp Reprod Med 2012;39:182-6.
2. Koike T, Minakami H, Motoyama M, Ogawa S, Fujiwara H, Sato I.
Reproductive performance after ultrasound-guided transvaginal ethanol
sclerotherapy for ovarian endometriotic cysts. Eur J Obstet Gynecol
Reprod Biol 2002;105:39-43.
interventional ultrasound sclerotherapy on women with hydrosalpinx
before in vitro fertilization and embryo transfer. Fertil Steril 2010;94:
2854-6.
ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog.
2014.09.019
suction cannula in the cervical canal because further dilatation
can lead to immediate and profuse cervical bleeding. -
Dubravko Habek, MD, PhD
Department of Obstetrics and Gynecology
Zagreb University School of Medicine
Sveti Duh University Hospital
Sveti Duh 64
HR-10000 Zagreb, Croatia
dubravko.habek@os.t-com.hr
Matija Prka, MD
Department of Obstetrics and Gynecology
Zagreb University School of Medicine
Zagreb, Croatia
The authors report no conflict of interest.
REFERENCES
1. Fylstra DL. Cervical pregnancy: 13 cases treated with suction curet-
tage and balloon tamponade. Am J Obstet Gynecol 2014;210:581.e1-5.
2. Habek D, Cerkez Habek J, Curzik D. Unrecognized cervical pregnancy
treated by suction curettage and cervicovaginal tamponade. Zentralbl
Gynakol 2002;124:184-5.
3. Okeahialam MG, Tuffnell DJ, O’Donovan P, Sapherson DA. Cervical
pregnancy managed by suction evacuation and balloon tamponade. Eur
J Obstet Gynecol Reprod Biol 1998;79:89-90.
ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog.
2014.09.023
REPLY
I wish to thank Drs Habek and Prka for their comments
regarding my article, “Cervical pregnancy: 13 cases treated
with suction curettage and balloon tamponade.”
JANUARY 2015 American Journal of Obstetrics & Gynecology 119