RESUMO
We describe a patient who underwent assisted reproduction techniques and was diagnosed with heterotopic cervical pregnancy, and then discuss the management of this entity, which is rare and has no standard protocols. Treatment consisted of intra-arterial methotrexate (50 mg/m(2) body surface area) and simultaneous selective embolization of uterine arteries. The literature is also reviewed to identify other approaches and outcomes.
Assuntos
Preservação da Fertilidade/métodos , Gravidez Ectópica/terapia , Adulto , Colo do Útero/diagnóstico por imagem , Feminino , Fertilização in vitro , Humanos , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Metrorragia/diagnóstico por imagem , Metrorragia/etiologia , Metrorragia/terapia , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/patologia , Fatores de Risco , Fumar , Ultrassonografia , Embolização da Artéria UterinaRESUMO
AIM OF THE STUDY: Prospective, observational study to determine the percentage of hysterectomies cancelled after a year of treatment with levonorgestrel intrauterine system (LNG-IUS) among women diagnosed with idiopathic menorrhagia. MAIN FINDINGS: Eighty-two women with a mean age of 44.3 + or - 4.9 were enrolled. Throughout 1-year follow-up, progressive and significant reduction was observed in number of days of bleeding (8.9 + or - 4.0 vs. 5.0 + or - 5.4), number of sanitary measures (29.3 + or - 19.4 vs. 8.1 + or - 10.8) and percentage of patients having intense/very intense bleeding (98.8%vs. 6.4%). Duration of menstrual cycle significantly increased from 26.9 + or - 5.5 to 52.6 + or - 33.6 days. Significant improvement in overall health-related quality of life was achieved. Patient satisfaction was good/very good in 70.7%. Considering only women who attended 12-month visit satisfaction reached 91.2%. 75.6% of scheduled hysterectomies were cancelled. Adverse effects were recorded in less than 40% of patients with no significant differences between visits. Adverse effects led to premature discontinuation of treatment in seven cases. No serious adverse effects were encountered. INTERPRETATION OF RESULTS: LNG-IUS meets the effectiveness and tolerability criteria for being considered as a first choice treatment option for women with idiopathic menorrhagia. Its use may contribute to decrease the large number of hysterectomies scheduled in Spain.