Conservative management of a 20-week cervical ectopic pregnancy with placenta percreta

Abstract

Cervical pregnancy is a rare form of ectopic pregnancy representing less than 1 % of all ectopic pregnancies. The implantation occurs in the cervical stroma below the level of the internal os. Failure to diagnose early, with continued progression of cervical ectopic pregnancy is associated with unpredictable occurrence of uncontrollable hemorrhage [1]. Early diagnosis is essential as it allows treatment with minimal intervention and reduction in overall morbidity and mortality. Different approaches have been described for conservative management of cervical ectopic pregnancy aimed at preserving future fertility. These include systemic or local methotrexate injection with intra-amniotic needle aspiration of fluid, local potassium chloride injection, dilatation and curettage, amputation of the cervix or partial trachelectomy [2]. Interventions employed in conservative management to decrease hemorrhage are intra-cervical tamponade with a Foley catheter, angiographic uterine artery occlusion, internal iliac artery ligation and cervical cerclage. However, there is still the potential for conservative management to fail and result in severe hemorrhage warranting surgical management such as definitive hysterectomy. Due to the rarity of cervical ectopic pregnancies and advanced cervical ectopic pregnancies historically being managed surgically, there is a lack of information in the literature on conservative management of advanced cervical ectopic pregnancies. At our institution, we successfully managed conservatively a second trimester cervical ectopic pregnancy at 15 weeks gestation [3]. We describe in this case report our experience on conservative management of a cervical ectopic pregnancy at 20 weeks gestation. To the best of our knowledge, this is the first case of a 20-week cervical ectopic pregnancy successfully managed conservatively followed by a subsequent live term uncomplicated delivery.