2nd trimester cervical ectopic pregnancy: case report

Introduction

The incidence of cervical ectopic pregnancy varies between 1/2,500 and 1/10,000. Cervical ectopic pregnancy is life-threatening, and one of the rarest forms of ectopic pregnancy. Sonographic diagnosis of cervical pregnancy has several challenges. The relationship between endometrial cavity and gestational sac should be considered carefully. Since it is seen rarely and one of the most significant reasons of mortality, we aimed to present a case of a cervical ectopic pregnancy diagnosed at 23 weeks of gestation.

Case(s)

Twenty-nine-year-old case with second pregnancy had no remarkable history except a previous cesarean delivery. The case who regularly visited external center for follow-up during current pregnancy admitted to our clinic with the pre-diagnosis of 22W2D pregnancy oligohydramnios and diastolic flow loss. The case who had 22W2D pregnancy according to early USGs had fetus competible to 19 weeks of gestational age in the USG performed. The case was followed up weekly with the diagnosis of oligohydramnios + IUGR (AC: 18W, FL: 20W) and diastolic flow loss. Placenta was low-lying and no clear relationship with cervix was established. The patient had normal results for first trimester combined test in her history, no rupture of membrane was described and there was no remarkable characteristic in the TORCH panel. The patient who refused vaginal examination was called for control. The patient came one week later and fetal cardiac activity was not seen in the ultrasonography. Fetal abdominal circumference was compatible with 18W4D. She was diagnosed with 23W1D oligohydramnios, intrauterine fetal death, transverse presentation, and previous 1 C/S. In the USG, fundus was observed as empty and in postpartum appearance. Fetus was observed around isthmic area. So it was suspected of servical ectopic pregnancy. The patient was hospitalized and applied laparotomy after preoperative evaluation. The abdomen was entered by epigastric and hypogastric incisions. The diagnosis of cervical ectopic pregnancy was confirmed by the laparotomy. In order to prevent possible severe bleeding, it was decided to apply Infrarenal Aorta occlusion. The aorta was suspended from Aorta bifurcation level by the consultant cardiovascular surgery physician. Double J catheters were placed on both ureters together with cystoscopy by consultant urologist. Also tourniquet was applied by Penrose over isthmic region. 1 cc heparin was administered and the aorta was clamped 2 minutes later. First the bladder was dissected. Just below the isthmus on the front side of uterus, fetus and its attachments were delivered by opening 3 cm transverse incision. Fetus was 240 g, 20 cm and male. Placenta and its attachments were cleaned. Intracervical foley condom was placed. It was inflated by 300 cc SF. Aorta clamp was opened. The procedure took about 25 minutes. One foley drain was placed into Douglas. Bleeding was checked. The case was taken to her bed in the unit with stable findings.

Conclusion

The diagnosis of servical ectopic pregnancy is generally limited with the first trimester cases in the literature. In cases referring at advanced weeks of gestation, prioritized evaluation of uterine fundus and fetus localization is essential to prevent delays in diagnosis.

Keywords

2nd Trimester, cervical ectopic pregnancy

	File/Dsecription
	Figure 1 The ultrasonographic characteristics of cervical ectopic pregnancy
	Figure 2 Intraoperative view of the uterus.
	Figure 3 Intraoperative view of the fetus