Cervical Pregnancy

　　First, etiology

　　It is not yet clear, and it may be related to the following factors:

　　1. The fertilized ovum moves too fast, entering the cervical canal before it has the ability to implant, and then grows and develops there.

　　2. Induced abortion, mid-trimester induction, cesarean section, and intrauterine devices can damage the endometrium or change the intrauterine environment, affecting the normal implantation of the ovum.

　　3. Abnormal uterine development, uterine malformation, uterine fibroids, endocrine disorders, and assisted reproductive technology are also possible related factors.

　　Second, pathogenesis

　　The embryo tissue is closely adhered to the cervical tissue, making it difficult to separate. The main part is below the internal os of the uterus, with no villous tissue in the uterine cavity. Trophoblasts and syncytiotrophoblasts in the gestational material can deeply penetrate the cervical muscle layer, and the fetus can survive. The site of villous tissue attachment can be seen in the cervical glands.

　　In severe cases, it can manifest as sudden massive vaginal bleeding leading to shock, and even threaten life. Shock is a clinical syndrome caused by insufficient tissue perfusion due to acute insufficiency of effective blood volume, which is a common complication in severe diseases in various clinical departments. The common feature of shock is insufficient effective blood volume, and although tissue and cell blood perfusion is compensated, it is still severely restricted.

　　To date, there have been no large-scale reports on cervical pregnancy. However, since the 1980s, the incidence of cervical pregnancy has shown an increasing trend. In 1966, Dees calculated the incidence rate to be 1:18,000 pregnancies, and some scholars believe it is even less. Ushakov et al. (1996) reported a rate of 1:9,000, and Karande et al. (1991) reported that the ectopic pregnancy rate in IVF technology was 3.7%, with cervical pregnancy accounting for 0.1% of ectopic pregnancies caused by IVF.

　　First, prognosis

　　Cervical pregnancy is relatively rare, but it is often misdiagnosed as a miscarriage, so it should be highly valued.

　　Second, nursing

　　1. Psychological care: Due to the acute onset of cervical pregnancy, patients are often anxious, nervous, and afraid. They often worry about their future fertility, and it is necessary to patiently explain the patient's condition and treatment process to the patient and their family. This helps to alleviate their mental concerns and actively cooperate with medical staff for treatment.

　　2. Strengthen oral care: MTX often causes varying degrees of skin and oral mucosal ulcers. It is advisable to instruct the patient to rinse with salt water or Dobbie's solution, use a soft-bristled toothbrush to brush teeth twice a day and after meals, keep the oral cavity clean, and encourage the patient to drink more water to alleviate the congestion and edema caused by pharyngeal ulcers.

　　3. Nursing care for uterine artery embolization: Uterine artery embolization can block the blood flow of the cervix, causing local ischemia and hypoxia, leading to the death of the cervical embryo and trophoblast cells, the atrophy of the lesion, and the cure. In nursing, routine skin preparation should be given to both inguinal groins before surgery, a urinary catheter should be left in place, fasting and water restriction for 2 hours, and routine blood routine and liver and kidney function tests. After surgery, closely observe the changes in vital signs, pay attention to changes in body temperature and gastrointestinal reactions, carefully observe whether there is bleeding at the puncture site, and after the puncture, there may be lower abdominal distension and pain. Follow the doctor's advice to give painkillers, and encourage the patient to get out of bed to move around after 24 hours.

　　Cervical pregnancy patients should supplement nutrition, eat more foods rich in protein and vitamins, and keep the bowels smooth. Since the patients are anemic, they should eat more foods rich in iron, such as spinach, black fungus, pork liver, and jujube. During MTX chemotherapy, it is advisable to eat soft foods without bones or thorns, rinse the mouth frequently, and strictly prevent the occurrence of oral ulcers. During the fever period, it is advisable to eat high-calorie and easily digestible foods, take meals in small and frequent doses, drink plenty of water, and pay attention to rinsing the mouth.

　　One, Dietetic recipes after cervical pregnancy surgery

　　1, Egg and Jujube Soup: 2 eggs, 10 jujubes, and an appropriate amount of brown sugar. Boil water in a pot, beat the eggs and let them sit, then add the jujubes and brown sugar, and simmer over low heat for 20 minutes. It has the effects of replenishing the middle and strengthening the qi, and nourishing the blood. It is suitable for nourishment and care after anemia and illness, as well as insufficient qi and blood after childbirth.

　　2, Lychee and Jujube Soup: 7 dried lychees and 7 dried jujubes. Boil them together with water, take one dose per day. It has the effects of nourishing the blood and producing body fluid. It is suitable for anemia in women and the nourishment and care of physical weakness after an induced abortion.

　　3, Soy milk and Rice Porridge: 2 bowls of soy milk, 50 grams of rice, and an appropriate amount of sugar. Rinse the rice clean, cook it into porridge with soy milk, and add sugar to taste when it is cooked. Take it on an empty stomach in the morning every day. It has the effects of harmonizing the spleen and stomach, clearing heat, and moisturizing dryness. It is suitable for the nourishment and care of physical weakness after an induced abortion.

　　4, Milk pigeon and枸杞 Soup: 1 milk pigeon, 30 grams of goji berries, a little salt. Remove the feathers and internal organs of the milk pigeon, wash it, put it in a pot with water and goji berries, and simmer with salt added when it is cooked. Eat the meat and drink the soup twice a day. It has the effects of replenishing qi, nourishing the blood, and regulating deficiency. It is suitable for physical weakness after induced abortion, physical weakness after illness, fatigue, and spontaneous sweating due to exterior deficiency.

　　5, Astragalus and Codonopsis Chicken: 1 old hen, 50 grams of Codonopsis, 50 grams of Astragalus, 50 grams of Chinese yam, 50 grams of jujube, and an appropriate amount of huangjiu (yellow wine). Add the killed, plucked, and eviscerated hen to the huangjiu, place the other four ingredients around the hen, steam over water, and eat in portions. It has the effects of replenishing qi and nourishing the blood. It is suitable for the adjustment and supplement after an induced abortion.

　　6, Sugar candied red dates: 50 grams of dried red dates, 100 grams of peanuts, 50 grams of brown sugar. After washing the dried red dates, soak them in warm water. Slightly boil the peanuts, peel and set aside. Put the dates and peanut skins in a small aluminum pot, add the water from the boiled peanuts, add an appropriate amount of water, and simmer for 30 minutes over low heat. Remove the peanut skins, add brown sugar, and cook until the brown sugar is dissolved and the sauce is reduced. It has the effects of nourishing the blood and regulating deficiency. It is suitable for anemia or low blood picture after an induced abortion.

　　Two, What foods are good for the body of cervical pregnancy patients

　　1, Firstly, ensure the supply of high-quality protein, adequate vitamins, and inorganic salts, especially to supplement sufficient iron to prevent anemia. Protein is an important component of antibodies, and if intake is insufficient, the body's resistance will decrease. Within half a month after an induced abortion, 1.5 to 2 grams of protein per kilogram of body weight should be provided, with an approximate daily amount of 100 to 150 grams. Therefore, it is advisable to eat more chicken, lean pork, eggs, dairy products, beans, and bean products, etc.

　　2. After surgery, due to the body being relatively weak, it is easy to sweat. Therefore, water should be supplemented in small amounts and in multiple doses to reduce the amount of water evaporation; more water-soluble vitamins are excreted in sweat, especially vitamin C, vitamin B1, and vitamin B2. Therefore, it is advisable to eat more fresh vegetables and fruits, which is also conducive to preventing constipation.

　　In terms of food selection, it is necessary to pay attention to both nutrition and easy digestion and absorption. On the basis of normal diet, fat should be appropriately restricted. Within a week after the operation, fat should be controlled at about 80 grams per day. For those with menstrual irregularity, it is taboo to eat刺激性 foods such as chili, wine, vinegar, pepper, ginger, etc., as these foods can all cause congestion of the stimulating organs and increase the amount of menstrual blood. It is also taboo to eat cold foods such as crabs, snails, and clams. Fresh fish, tender chicken, eggs, animal liver, animal blood, lean meat, soy products, milk, jujube, lotus seeds, fresh fruits and vegetables can be provided. It is not advisable to eat or eat less greasy and cold foods; it is not advisable to eat radish, hawthorn, bitter melon, tangerine, and other qi-regulating, blood-activating, and cold foods. It is advisable to eat more easily digestible foods. The time for tonifying should be about half a month, and for those with weak bodies, poor constitution, and excessive bleeding, the time for tonifying can be appropriately extended.

　　Three, What foods are bad for the body of cervical pregnancy patients

　　It is taboo to eat刺激性 foods such as chili, wine, vinegar, pepper, ginger, etc., as these foods can all cause congestion of the stimulating organs. It is also taboo to eat cold foods such as crabs, snails, and clams.

　　Cervical pregnancy should not eat aquatic products with abortifacient effects. Many aquatic products have the effect of promoting blood circulation and softening hard lumps, which can cause bleeding and abortion in early pregnancy. For example, crabs, although delicious, are cold in nature, have the effect of promoting blood circulation and removing blood stasis, especially the claws of crabs have a significant abortifacient effect; turtle, also known as biejia, has the effect of nourishing Yin and benefiting the liver and kidney. For most people, it is a dish rich in nutrition and nourishing the body. However, the nature of turtle is salty and cold, and it has a strong effect of promoting blood circulation, dispersing blood stasis, and therefore has the drawback of abortifacient effect; seaweed is salty and cold in nature, with the function of softening hard lumps, dispersing phlegm and blood stasis, so it also has the abortifacient effect.

　　Cervical pregnancy should not eat slippery foods. Rice sprout, also known as Coix Seed, is a plant seed that is used both as a medicine and as food. Its nature is slippery, and pharmacological experiments have shown that Coix Seed has an excitatory effect on the uterine muscle, promoting uterine contraction, thus there is a possibility of inducing abortion; Portulaca oleracea, also known as melon seed vegetable, is both a medicine and can be eaten as a vegetable. However, it is cold and slippery in nature, and experimental evidence shows that the juice of Portulaca oleracea also has a significant excitatory effect on the uterus, increasing the frequency and intensity of uterine contractions, which is easy to cause abortion.

　　Cervical pregnancy should not eat apricots and almonds. Apricots and almonds are sour and hot in nature, and have the effect of滑胎, due to the heavy Qi and heat of pregnancy, it is generally recommended to follow the principle of 'diet should be light before delivery', and the hot nature and滑胎 characteristics of apricots are a great taboo for pregnant women. Almonds contain a highly toxic substance hydrogen cyanide, which can cause tissue asphyxiation and death; eating 7 to 10 almonds can be fatal to children. Therefore, to avoid the toxic substances passing through the placental barrier and affecting the fetus, pregnant women are prohibited from eating almonds.

　　Cervical pregnancy should not eat black fungus. The scientific name of black fungus is桑耳, although it is popular for its nourishing and stomach-soothing effects, it also has the function of promoting blood circulation and removing blood stasis, which is not conducive to the stability and growth of the embryo, so it should be avoided. Cervical pregnancy should not eat hawthorn. Hawthorn has the effects of promoting blood circulation and removing blood stasis, and at the same time, it has the effect of contracting the uterus, so it should be avoided.

　　One, Prevention

　　In recent years, the incidence of ectopic pregnancy has shown an increasing trend. This is an important issue facing us. Although the exact etiology of the disease is not yet fully clear, many related factors are clear. Reducing the high-risk factors can achieve the purpose of prevention.

　　1. Strengthen the publicity and education of the prevention and treatment of sexually transmitted diseases and social governance.

　　2. When placing an intrauterine device or performing artificial abortion and other intrauterine operations, it is crucial to strictly follow the standard operating procedures and infection prevention measures.

　　3. Infection of pelvic soft tissue should be treated early and cured completely in one go.

　　4. Actively treat endometriosis.

　　5. After using ovulation induction drugs, it is necessary to promptly exclude ectopic pregnancy and composite pregnancy when suspected of early pregnancy or after successful assisted reproduction.

　　6, Publicize the dangers of smoking and prohibit drug abuse.

　　7, Those who have had multiple dilation and curettage should be vigilant when pregnant again, and a B-ultrasound examination should be done to see if the embryo is 'living' in the uterus. Once an abnormality is found, appropriate measures should be taken immediately.

　　8, If vaginal bleeding occurs after pregnancy, do not just confirm it as a common threatened miscarriage, do not act on your own, and be sure to go to the hospital to find out the truth to avoid any accidents.

　　Two, postoperative cervical pregnancy food therapy recipe

　　1, Egg and Jujube Soup: 2 eggs, 10 jujubes, and an appropriate amount of brown sugar. Boil water in a pot, beat the eggs and let them sit, then add the jujubes and brown sugar, and simmer over low heat for 20 minutes. It has the effects of replenishing the middle and strengthening the qi, and nourishing the blood. It is suitable for nourishment and care after anemia and illness, as well as insufficient qi and blood after childbirth.

　　2, Lychee and Jujube Soup: 7 dried lychees and 7 dried jujubes. Boil them together with water, take one dose per day. It has the effects of nourishing the blood and producing body fluid. It is suitable for anemia in women and the nourishment and care of physical weakness after an induced abortion.

　　3, Soy milk and Rice Porridge: 2 bowls of soy milk, 50 grams of rice, and an appropriate amount of sugar. Rinse the rice clean, cook it into porridge with soy milk, and add sugar to taste when it is cooked. Take it on an empty stomach in the morning every day. It has the effects of harmonizing the spleen and stomach, clearing heat, and moisturizing dryness. It is suitable for the nourishment and care of physical weakness after an induced abortion.

　　4, Milk pigeon and枸杞 Soup: 1 milk pigeon, 30 grams of goji berries, a little salt. Remove the feathers and internal organs of the milk pigeon, wash it, put it in a pot with water and goji berries, and simmer with salt added when it is cooked. Eat the meat and drink the soup twice a day. It has the effects of replenishing qi, nourishing the blood, and regulating deficiency. It is suitable for physical weakness after induced abortion, physical weakness after illness, fatigue, and spontaneous sweating due to exterior deficiency.

　　5, Astragalus and Codonopsis Chicken: 1 old hen, 50 grams of Codonopsis, 50 grams of Astragalus, 50 grams of Chinese yam, 50 grams of jujube, and an appropriate amount of huangjiu (yellow wine). Add the killed, plucked, and eviscerated hen to the huangjiu, place the other four ingredients around the hen, steam over water, and eat in portions. It has the effects of replenishing qi and nourishing the blood. It is suitable for the adjustment and supplement after an induced abortion.

　　6, Sugar candied red dates: 50 grams of dried red dates, 100 grams of peanuts, 50 grams of brown sugar. After washing the dried red dates, soak them in warm water. Slightly boil the peanuts, peel and set aside. Put the dates and peanut skins in a small aluminum pot, add the water from the boiled peanuts, add an appropriate amount of water, and simmer for 30 minutes over low heat. Remove the peanut skins, add brown sugar, and cook until the brown sugar is dissolved and the sauce is reduced. It has the effects of nourishing the blood and regulating deficiency. It is suitable for anemia or low blood picture after an induced abortion.

　　Three, what is good for the body of a patient with cervical pregnancy

　　1, Firstly, ensure the supply of high-quality protein, adequate vitamins, and inorganic salts, especially to supplement sufficient iron to prevent anemia. Protein is an important component of antibodies, and if intake is insufficient, the body's resistance will decrease. Within half a month after an induced abortion, 1.5 to 2 grams of protein per kilogram of body weight should be provided, with an approximate daily amount of 100 to 150 grams. Therefore, it is advisable to eat more chicken, lean pork, eggs, dairy products, beans, and bean products, etc.

　　2, After surgery, due to the body's weakness, it is prone to sweating. Therefore, it is recommended to replenish fluids in small amounts and multiple times to reduce the amount of water evaporation; a large amount of water-soluble vitamins are excreted in sweat, especially vitamin C, vitamin B1, and vitamin B2. Therefore, it is advisable to eat more fresh vegetables and fruits. This also helps prevent constipation.

　　In terms of food selection, it is necessary to pay attention to both nutrition and easy digestion and absorption. On the basis of normal diet, fat should be appropriately restricted. Within a week after the operation, fat should be controlled at about 80 grams per day. For those with menstrual irregularity, it is taboo to eat刺激性 foods such as chili, wine, vinegar, pepper, ginger, etc., as these foods can all cause congestion of the stimulating organs and increase the amount of menstrual blood. It is also taboo to eat cold foods such as crabs, snails, and clams. Fresh fish, tender chicken, eggs, animal liver, animal blood, lean meat, soy products, milk, jujube, lotus seeds, fresh fruits and vegetables can be provided. It is not advisable to eat or eat less greasy and cold foods; it is not advisable to eat radish, hawthorn, bitter melon, tangerine, and other qi-regulating, blood-activating, and cold foods. It is advisable to eat more easily digestible foods. The time for tonifying should be about half a month, and for those with weak bodies, poor constitution, and excessive bleeding, the time for tonifying can be appropriately extended.

　　What is bad for the body for patients with cervical pregnancy?

　　It is taboo to eat刺激性 foods such as chili, wine, vinegar, pepper, ginger, etc., as these foods can all cause congestion of the stimulating organs. It is also taboo to eat cold foods such as crabs, snails, and clams.

　　Cervical pregnancy should not eat aquatic products with abortifacient effects. Many aquatic products have the effect of promoting blood circulation and softening hard lumps, which can cause bleeding and abortion in early pregnancy. For example, crabs, although delicious, are cold in nature, have the effect of promoting blood circulation and removing blood stasis, especially the claws of crabs have a significant abortifacient effect; turtle, also known as biejia, has the effect of nourishing Yin and benefiting the liver and kidney. For most people, it is a dish rich in nutrition and nourishing the body. However, the nature of turtle is salty and cold, and it has a strong effect of promoting blood circulation, dispersing blood stasis, and therefore has the drawback of abortifacient effect; seaweed is salty and cold in nature, with the function of softening hard lumps, dispersing phlegm and blood stasis, so it also has the abortifacient effect.

　　Cervical pregnancy should not eat slippery foods. Rice sprout, also known as Coix Seed, is a plant seed that is used both as a medicine and as food. Its nature is slippery, and pharmacological experiments have shown that Coix Seed has an excitatory effect on the uterine muscle, promoting uterine contraction, thus there is a possibility of inducing abortion; Portulaca oleracea, also known as melon seed vegetable, is both a medicine and can be eaten as a vegetable. However, it is cold and slippery in nature, and experimental evidence shows that the juice of Portulaca oleracea also has a significant excitatory effect on the uterus, increasing the frequency and intensity of uterine contractions, which is easy to cause abortion.

　　Cervical pregnancy should not eat apricots and almonds. Apricots and almonds are sour and hot in nature, and have the effect of滑胎, due to the heavy Qi and heat of pregnancy, it is generally recommended to follow the principle of 'diet should be light before delivery', and the hot nature and滑胎 characteristics of apricots are a great taboo for pregnant women. Almonds contain a highly toxic substance hydrogen cyanide, which can cause tissue asphyxiation and death; eating 7 to 10 almonds can be fatal to children. Therefore, to avoid the toxic substances passing through the placental barrier and affecting the fetus, pregnant women are prohibited from eating almonds.

　　Cervical pregnancy should not eat black fungus. The scientific name of black fungus is桑耳, although it is popular for its nourishing and stomach-soothing effects, it also has the function of promoting blood circulation and removing blood stasis, which is not conducive to the stability and growth of the embryo, so it should be avoided. Cervical pregnancy should not eat hawthorn. Hawthorn has the effects of promoting blood circulation and removing blood stasis, and at the same time, it has the effect of contracting the uterus, so it should be avoided.

　　Fifth, Western medical treatment methods for cervical pregnancy

　　In the past, the discovery of cervical pregnancy was often late, with a lot of bleeding, few abortifacient drugs, so emergency total hysterectomy was used to deal with it. In the past 20 years, there has been a significant change. After the discovery of cervical pregnancy, it should be determined according to whether the patient is a primipara (according to Yao's statistics, about half of them are primiparas) or a multipara, the patient's requirements for fertility, and the general condition of the patient at the time of onset.

　　1. If the patient has children and does not expect to preserve fertility, and there is a lot of bleeding, regardless of the gestational age, an emergency total hysterectomy should be performed to prevent hemorrhagic shock.

　　In the past, cervical pregnancy was often diagnosed late due to life-threatening hemorrhage during curettage when suspected of inevitable miscarriage, and hysterectomy was performed. With the improvement of surgical techniques, hysterectomy has reduced the mortality rate from 40% to nearly 0%, but it cannot preserve the fertility of women. Gao Qingwen et al. reported 3 cases in 1995 of vaginal bleeding due to amenorrhea, irregular painless vaginal bleeding, and curettage leading to massive vaginal bleeding, which was ineffective after packing with gauze and oxytocin treatment and eventually led to total hysterectomy. The postoperative pathological examination diagnosed cervical pregnancy. With the improvement of detection methods, cervical pregnancy can be diagnosed early, winning time for other treatment methods. Total hysterectomy is mainly used for uncontrollable massive hemorrhage and women without fertility requirements.

　　(1) Hysteroscopic fetus removal or aspiration: Around 4-6 weeks of pregnancy, with little vaginal bleeding and not very high blood β-hCG levels, hysteroscopic fetus removal or aspiration can be chosen. It has the following advantages: Under hysteroscopy, the implantation site of the embryo can be clearly identified; The embryo can be completely removed under direct vision; Hemorrhage sites can be electrocoagulated to stop bleeding under direct vision; The treatment is complete and thorough, and there is no need for long-term observation.

　　Firstly, a vasoconstrictor was injected into the cervix, ligated the cervical branches of the uterine artery at the site of pregnancy, expanded the cervical canal to 10mm, and operated under direct vision using a 27French Storz prostatectomy retractor. Sorbitol at 2.7% or mannitol at 5.4% was used as the distension fluid, and there was no bleeding during the expansion process. An ectopic pregnancy sac was seen on the left side of the cervical canal between the internal and external os of the cervix. The pregnancy sac was excised under direct vision using a LOOP retractor, and no residual tissue was found. No abnormalities were found in the uterine cavity, the operation was successful, and there was no vaginal bleeding postoperatively. The blood β-hCG level decreased from 3192 IU/L to 282 IU/L on the first day after the operation.

　　Roussis et al. treated a patient with cervical pregnancy who continued to bleed 40 days after systemic methotrexate (MTX) therapy. Under hysteroscopy, the bleeding site in the cervical canal was found, and the fetus was aspirated using negative pressure to stop the bleeding. Although hysteroscopy has obvious advantages in diagnosis and treatment, it is not suitable for all cases of cervical pregnancy, and its treatment has certain limitations. Large gestational sacs may be accompanied by significant dilation and distortion of the cervix, with abundant blood supply. The treatment and operation procedures of hysteroscopy are prone to cause life-threatening hemorrhage. At this time, the method of administering MTX within the gestational sac remains the first-line treatment. The female reproductive structure

　　(2) Dilation and curettage: In general, dilation and curettage is not performed for cervical pregnancy, except in cases of massive vaginal bleeding and the need for emergency hemostasis, where temporary gentle techniques are used to quickly aspirate or scrape the embryonic tissue and then pack for hemostasis, while preparing other more effective emergency measures, such as iliac artery embolization or selective uterine artery embolization for hemostasis. If this special technique is not available, laparotomy for internal iliac artery ligation or hysterectomy can be performed.

　　(3) Arterial embolization for hemostasis: Cervical pregnancy often leads to uncontrolled, life-threatening hemorrhage, making it a difficult point in treatment. In the past, conservative treatments for actively controlling bleeding included laparotomy for bilateral internal iliac artery ligation, Foley catheter ball packing for hemostasis, etc. However, since the 21st century, with the development of angiography technology, vascular embolization has become possible, which can effectively control massive hemorrhage, thus providing necessary conditions for other conservative treatment methods. The current conservative MTX treatment may still cause massive hemorrhage due to reasons such as an overly large gestational sac or different sensitivity to the drug, and ultimately, a total hysterectomy may be required. If vascular造影embolization technology is used simultaneously with MTX treatment, it can effectively control bleeding, improve the success rate of MTX treatment, and expand the application range of MTX. Gilbert et al. successfully controlled massive hemorrhage with iliac artery embolization in 80% of cases.

　　Marston et al. treated a case of cervical pregnancy at 8 weeks of pregnancy with MTX multiple injections, with a blood β-hCG level of 48020 IU/L, B-ultrasound showing a fetal sac diameter of 2 cm, with fetal heartbeat, and trophoblast invasion throughout the right cervical stroma. MTX was administered intramuscularly at 1 mg/kg per day, and folic acid at 0.1 mg/kg was alternated, with 4 times as one course, a total of 2 courses. On the 8th day after the start of treatment, a sudden vaginal hemorrhage occurred, and the bleeding was immediately reduced after immediate vaginal packing and embolization with gelatin sponge in the right internal iliac artery and left uterine artery, without blood transfusion.

　　On the 14th day after the start of treatment, MTX (the second course) was injected, and on the 23rd day, the blood β-hCG level decreased to 772 IU/L, and on the 30th day, it was negative, with a good recovery. Pregnant again after 4 months. Early diagnosis of cervical pregnancy is very important. Both systemic and local MTX administration are good treatment methods. If necessary,辅以髂内动脉栓塞技术，可预防或治疗大出血的发生.

　　2. Conservative treatment for cervical pregnancy often requires a complex (i.e., 2 or more) method to be effective.

　　(1) Conservative surgical treatment: Dilation of the cervix and curettage is the most commonly used method, which can be performed after pretreatment. The methods of pretreatment include ligation of the descending branch of the uterine artery through the vagina.

　　(2) Angiography and arterial embolization: Angiography and bilateral uterine artery embolization can replace bilateral internal iliac artery ligation. Embolization therapy performed simultaneously with MTX treatment can successfully stop bleeding. Uterine artery embolization treatment itself does not affect future menstrual and fertility. The side effects of this method are fever and pain, which can all be self-resolved; although there are reports of sciatic nerve injury, bladder or rectal necrosis, they are extremely rare.

　　(3) Drug treatment: There are many methods of drug treatment, including systemic MTX treatment with single or multiple doses, intravesicular injection of KCl or MTX, or a combination of both, but they are generally used for cervical pregnancy with little or no bleeding.

　　① Calculate the intramuscular injection of a single dose of MTX as 50mg/m2. Storall reported a success rate of 94%.

　　② Inject 0.5～1mg/kg of MTX intramuscularly every other day, that is, a total of 4 times on the 1st, 3rd, 5th, and 7th days, or 0.1mg/kg of leucovorin can be added on the 2nd, 4th, 6th, and 8th days to reduce its toxicity. For those with fetal heartbeats, 20% KCl can be injected into the gestational sac under vaginal ultrasound guidance, and then 50mg of MTX/m2 can be injected intramuscularly after the fetal heartbeat disappears. For those without children and no desire to have children, a total hysterectomy can be performed to avoid uncontrollable bleeding caused by curettage. For those with a desire to have children, curettage can be performed to remove the pregnancy material, but after curettage, due to the difficulty in contracting the cervix, the blood sinus on the placental attachment surface is not easy to close, which often leads to massive bleeding, difficult to stop. The methods of hemostasis include packing the cervix with gauze to compress and stop bleeding, local injection of prostaglandins, circumferential suture of the cervix, or cervical hysterectomy, etc. If these methods are ineffective, a total hysterectomy must still be performed. Literature reports that pre-treatment such as ligation of the descending branch of the uterine artery through the vagina, cervical cerclage, bilateral uterine artery embolization, injection of vasoconstrictors into the cervix, and injection of methotrexate into the gestational sac before curettage can effectively reduce massive bleeding caused by curettage and preserve the uterus. In recent years, there have been continuous reports of successful drug treatment for early cervical pregnancy, which can reduce bleeding during curettage by taking methotrexate orally or by intramuscular injection before curettage, or simple drug treatment: ① Inject 0.5～4mg/kg of methotrexate intramuscularly or intravenously a total of 4 times, alternating with 0.1mg/kg of leucovorin every other day; ② Inject 50mg of methotrexate intramuscularly once;

　　③ Administer 50mg of methotrexate intravesicularly under B-ultrasound guidance.

　　Prognosis: Cervical pregnancy is rare, but it is prone to be misdiagnosed as a miscarriage, so it should be highly valued.