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Case Reports
. 2021 Oct 29;13(10):e19113.
doi: 10.7759/cureus.19113. eCollection 2021 Oct.

Cervical Ectopic Pregnancy: A Multidisciplinary Approach

Francisco Évora  1 , Kristina Hundarova  1 , Fernanda Águas  1 , Giselda Carvalho  1
Affiliations
Case Reports

Cervical Ectopic Pregnancy: A Multidisciplinary Approach

Francisco Évora et al. Cureus. .

Abstract

Cervical ectopic pregnancy is a rare but life-threatening condition in which early diagnosis and treatment are key to a successful outcome. In the past, this diagnosis led inevitably to a hysterectomy due to the risk of massive bleeding. Currently, the most effective method of treatment is yet to be found. We report a case of a 31-year-old nulliparous female with six weeks of amenorrhea and vaginal bleeding. The first approach missed the diagnosis, but an ultrasound performed by an expert revealed a gestational sac with an embryo in the cervical canal. The fertility-sparing therapeutic strategy involved performing treatment with systemic and local methotrexate, followed by embolization of the uterine artery and cervical curettage to remove the trophoblast. Our aim is to strengthen the importance of an early diagnosis and multidisciplinary perspective. Uterine artery embolization was the key to minimizing bleeding, enabling a treatment that preserved fertility.

Keywords: cervical ectopic pregnancy; conservative surgery; curettage; fertility-sparing treatment; intra-amniotic injection; methotrexate; surgical hysteroscopy; trophoblast excision; uterine artery embolization; uterine bleeding.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Physical examination – cervix enlarged and violet
Figure 2
Figure 2. Transvaginal ultrasound (axial plane) – gestational sac in the cervical canal containing an 8 mm embryo
Figure 3
Figure 3. Transvaginal ultrasound (sagittal plane) – "8" or hourglass uterine shape caused by cervical enlargement
Figure 4
Figure 4. Embolization of the cervical branch of the left uterine artery
Figure 5
Figure 5. Abortion product removed by curettage
Figure 6
Figure 6. Transvaginal ultrasound (axial plane) of the residual trophoblastic tissue in resorption – nodular and cavitated image measuring 18 x 13 mm
Figure 7
Figure 7. Transvaginal ultrasound (axial plane) of the residual trophoblastic tissue in resorption – mild peripheral vascularization
See this image and copyright information in PMC

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