Successful management of cervical ectopic pregnancy with embryo reduction: report of three cases

A Systematic Review about Cervical Pregnancy and our Experience

Background

Cervical ectopic pregnancy is a relatively rare type of ectopic pregnancy and has no standardized guidelines for management.

Methods

This systematic review is based on the collection of case reports, published in PubMed/MEDLINE about the resolution of ectopic cervical pregnancies over the last decade and the presentation of a case managed in our healthcare unit. Studies involving cervical pregnancy in the first trimester with the presence of a viable embryo and β-hCG in the serum below 100.000 mIU/mL were included, while heterotopic pregnancies were excluded.

Results

Nineteen articles reporting twenty-three case reports are demonstrated explicitly emphasizing on the management techniques. There is no established approach for the management of this type of ectopic pregnancy.

Conclusion

It is important to consider the conservative approaches as first-line treatment in all cases of cervical pregnancy preserving fertility. Minimally invasive methods are also described and preferred as second-line treatment, as reported in our literature review.

The role of contrast-enhanced ultrasound in the diagnosis and guiding therapy of early cervical ectopic pregnancy

We described the ultrasonic imaging characteristics of four patients with cervical ectopic pregnancy (CEP) and inevitable miscarriage (IM) with the gestational sac (GS) located at the level of the cervical canal discussed and analyzed them in combination with relevant data, such as surgery and outcomes. It was found that contrast-enhanced ultrasound (CEUS) could provide a more accurate differential diagnosis of early CEP and IM than conventional ultrasound (US), thus providing more effective guidance for clinical therapy. In CEP, CEUS shows sustained annular hyperenhancement of the GS wall. However, CEUS shows nonenhancement or pedicle-like enhancement in IM with the GS located at the level of the cervical canal.

Second-Trimester Cervico-Isthmic Pregnancy after Donor Egg In Vitro Fertilization, Complicated with Placenta Accreta – Case Report

BACKGROUND: Cervical gestations are rare potentially life-threatening conditions. Although these can cause massive hemorrhage, most of them abort during the first trimester without having been diagnosed. However, cervico-isthmic pregnancies are more likely to persist to an advanced gestation in the second and third trimester owing the need for hysterectomy due to defect placentation. CASE PRESENTATION: We presented a rare case of cervical pregnancy after donor egg in vitro fertilization procedure, with no previous pregnancies, medical, and surgical history. Our patient rejected early termination of pregnancy at 5 gestational weeks. Pregnancy continued until 16 weeks when she was hospitalized and terminated due to medical grounds with curettage. Post-operative period was uneventful until day 20, when she was admitted with suspicion of retained placental tissue and endometritis. A hysterectomy was done with blood transfusion due to excessive blood loss. Histologic examination confirmed placenta accreta spectrum disorder. CONCLUSION: Cervical pregnancy can be treated conservative if timely diagnosed by early ultrasound, which can reduce the chances of severe life-threatening hemorrhage necessitating hysterectomy or blood transfusion.