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Management of Cervical Ectopic Pregnancy
Abstract Number: RF7B10-163
Abstract Type: Case Report Case Series
Introduction: Cervical ectopic pregnancy is a rare form of extrauterine pregnancy, often complicated by massive hemorrhage. We present a case of a multiparous parturient with cervical ectopic pregnancy diagnosed at 13 weeks EGA.
Case presentation: An otherwise healthy 33 yo G2P1 with history of 1 prior cesarean delivery presented at 10 2/7 weeks EGA with vaginal bleeding. Ultrasound performed at that time was suspicious for threatened abortion. Follow up ultrasound performed at 13 1/7 weeks EGA was suspicious for cervical pregnancy. MRI of the pelvis was then performed and showed an empty uterus, dilated cervix, and gestational sac within the cervical canal, consistent with the diagnosis. After consultation with gynecology-oncology and interventional radiology, the patient was admitted for pregnancy termination. Uterine artery embolization (UAE) was performed successfully, however post-procedure the patient became febrile to 102.8 and broad spectrum antibiotic coverage was initiated. Fetal cardiac activity remained present, and ultrasound-guided KCl injection was administered into the fetal thorax until asystole was achieved. Due to continued fevers, the patient underwent suction D & C under general endotracheal anesthesia. Large bore IV access and invasive arterial monitoring were placed due to potential for massive hemorrhage. The patient tolerated the procedure well and remained hemodynamically stable, with estimated blood loss of 621 mL. She received 2 units pRBC on POD #1 for Hb 5.8. Her hospital course was otherwise uncomplicated and she was discharged home on POD #5.
Discussion: Cervical ectopic pregnancy is rare and constitutes an estimated < 1% of ectopic pregnancies (1,2). Ultrasound findings include diffuse intrauterine echoes, an empty but enlarged uterus, and gestational sac located within the cervical canal with cervical dilation (3). The most common presentation is first trimester vaginal bleeding (5), and therefore the diagnosis may initially be confused with threatened abortion, as was the case with our patient. Risk factors include prior cesarean delivery, prior D&C, and infertility (3). Cervical ectopic pregnancy has been managed successfully with methotrexate, UAE, ligation of cervical branches of the uterine arteries, foley balloon tamponade, intracervical vasopressin injection, and D&C. Hysterectomy should be reserved for cases of life threatening hemorrhage. (1,2,3,4)