{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T22:36:09Z","timestamp":1787610969334,"version":"build-2736575974"},"reference-count":55,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babes University of Medicine and Pharmacy Timisoara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: CP (CP) and HCP (HCP) are rare and high-risk conditions, often historically managed with radical intervention and associated with hemorrhage and fertility loss. Objective: To summarize current evidence on the conservative, fertility-preserving management of cervical and heterotopic cervical pregnancies and to illustrate a stepwise pharmacologic protocol applied in our tertiary center. Methods: A narrative literature review (PubMed, Scopus, Web of Science; inception\u2014July 2025) was conducted using the following key terms: \u201cCP,\u201d \u201cHCP,\u201d \u201cmethotrexate,\u201d \u201cmifepristone,\u201d \u201cmisoprostol,\u201d \u201cuterine artery embolization,\u201d \u201chysteroscopy,\u201d and \u201cDoppler ultrasound.\u201d We integrated a personal institutional case that applied stepwise pharmacologic priming, Doppler-guided surveillance, and delayed evacuation. Results: Evidence\u2014primarily from case reports and small series\u2014supports conservative, multi-modal strategies combining systemic or local methotrexate \u00b1 mifepristone, timed to Doppler-confirmed vascular regression, before surgical intervention. Adjuncts such as misoprostol, hysteroscopic resection, balloon tamponade, and uterine artery embolization further reduce hemorrhage risk while maintaining fertility. Our case utilized a novel, incremental dosing strategy of mifepristone followed by methotrexate, a week-long interval to confirm vascular involution via Doppler, and delayed suction curettage with minimal blood loss. Conclusions: Conservative, imaging-guided management is promising for reducing hemorrhagic complications and preserving fertility in CP\/HCP. Future multicenter registries and standardized Doppler-based protocols are urgently needed to refine decision-making and optimize outcomes.<\/jats:p>","DOI":"10.3390\/jcm14217489","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T05:20:44Z","timestamp":1761196844000},"page":"7489","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Minimizing Hemorrhage Risk Strategies in Cervical Pregnancy\u2014Stepwise Pharmacologic Priming and Delayed Surgical Evacuation: A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"given":"Victor Bogdan","family":"Buciu","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Florin R\u0103zvan","family":"Mogo\u0219","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolae","family":"Albulescu","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine II, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Centre for Molecular Research in Nephrology and Vascular Disease, \u201cPius Br\u00e2nzeu\u201d County Emergency Hospital, Department of Cardiology, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8178-0449","authenticated-orcid":false,"given":"Sebastian","family":"Ciurescu","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2520-7636","authenticated-orcid":false,"given":"Dorin","family":"Novacescu","sequence":"additional","affiliation":[{"name":"Department of Microscopic Morphology, Discipline of Histology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9214-302X","authenticated-orcid":false,"given":"Mihai","family":"Ionac","sequence":"additional","affiliation":[{"name":"Department of Scientific Research Methodology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0865-0054","authenticated-orcid":false,"given":"Abhinav","family":"Sharma","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"University Clinic of Internal Medicine and Ambulatory Care, Prevention and Cardiovascular Recovery, Department VI-Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2824-7182","authenticated-orcid":false,"given":"Nilima Rajpal","family":"Kundnani","sequence":"additional","affiliation":[{"name":"University Clinic of Internal Medicine and Ambulatory Care, Prevention and Cardiovascular Recovery, Department VI-Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Research Centre of Timisoara Institute of Cardiovascular Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Serban","sequence":"additional","affiliation":[{"name":"Department of Obstetrics-Gynaecology, Discipline of Obstetrics-Gynecology, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Stabile, G., Mangino, F.P., Romano, F., Zinicola, G., Ricci, G., and Ectopic, C.P. (2020). Treatment Route. Medicina, 56.","DOI":"10.3390\/medicina56060293"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3269","DOI":"10.1080\/07853890.2022.2136747","article-title":"The efficacy of mifepristone combined with methotrexate for the treatment of ectopic pregnancy: A systematic review and meta-analysis","volume":"54","author":"Su","year":"2022","journal-title":"Ann. Med."},{"key":"ref_3","first-page":"285","article-title":"Management of cervical ectopic pregnancy after unsuccesful methotrexate treatment","volume":"12","author":"Topolovec","year":"2014","journal-title":"Iran. J. Reprod. 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Biol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7489\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T05:56:24Z","timestamp":1761198984000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7489"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,22]]},"references-count":55,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217489"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217489","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,22]]}}}