Cervico-isthmic pregnancy with cervical placenta accreta

Abstract

Abstract Cervical pregnancies are a rare form of ectopic pregnancies. The reported incidence is estimated to affect one in 1000 to 18,000 pregnancies. Whereas true cervical pregnancies are rare, cervico-isthmic pregnancies are more common, and in addition more lethal as the maternal risk for massive hemorrhage increases with the advancement of the gestational period. Risk factors include tubal disease, uterine surgery as well as in vitro fertilization. We report a case of a 35-year-old woman at 20 weeks of gestation who was referred to our department because of cervical shortening and recurrent painless vaginal bleeding. Transvaginal ultrasound revealed that the placental implantation site was located within the cervix and the uterine isthmus while the fetus was developing in the uterus. Furthermore, we suspected placenta accreta. After counseling expectant management was chosen. At 31+5 weeks of gestation the patient developed severe vaginal bleeding leading to an emergency cesarean section with hysterectomy after an unsuccessful effort to stem the hemorrhage conservatively. The pathology report confirmed our sonographic findings. It can be concluded that cervico-isthmic pregnancies are rare implantation disorders that require interdisciplinary peripartum management. Expectant management can be offered. Preterm delivery and probable requirement of a hysterectomy need to be discussed with the patient.