A case of cervical ectopic pregnancy

Objective

Cervical ectopic pregnancy (CP) is a rare form of ectopic pregnancy and its incidence is less than 0,1% of all ectopic pregnancies. Improvement in ultrasound resolution and detection of these pregnancies in the early stages has led to the development of more conservative treatments that attempt to limit morbidity and preserve fertility. We present the case of a 38-year old woman (gravida 1, para 0) who was found to have a cervical ectopic pregnancy at six weeks of gestation.

Case(s)

A multigravida 38-year-old patient (gravida 1, para 0) presented to our clinic with complaint of delayed menses. At the vaginal examination of the patient, vagina and cervix were in normal appearances. There was no painful cervical motion at vaginal palpation. A transvaginal ultrasound showed a 5 weeks gestational sac without fetal pole implanted in the cervix. BhCG level was 4023 mIU/ml and hemoglobin level was 11,8 g/dl. The diagnosis of cervical pregnancy was made with these findings. When the patient was informed about her condition, she said that it was an unintended pregnancy and she wanted to terminate her pregnancy. After receiving the consent of her husband, preoperative preparation was made. Curettage was performed in the operating room. No complication occurred. The patient was discharged after postoperative 6rd hour.

Discussion

Historically, it was difficult to diagnose CPs and they were identified at later gestational ages compared to the tubal ectopic pregnancies. Since the cervical tissue had a relatively large gestational sac and a highly vascular nature, treatment of CP was often associated with massive hemorrhage from the implantation site, frequently requiring hysterectomy. In a study performed by Matteo et al. in 2006, the authors also used hysteroscopy to successfully resect a CP (after two cycles of methotrexate treatment in this patient) and they found that the hemostasis could be achieved via direct hysteroscopic coagulation of bleeding vessels.

Conclusion

The principal targets in the management of any cervical ectopic pregnancy are to minimize hemorrhage and preserve future fertility. Therefore, these goals should be kept in mind when choosing treatment modalities

Keywords

Cervical pregnancy, ectopic pregnancy