Effective Hemostasis in Cervical Ectopic Pregnancy With Packing Without Hysterolaparoscopy or Devascularization

Abstract

A 29-year-old primigravida presented with 2 months of amenorrhea and 4 days of spotting 4 days, with no other significant history. Her vital signs were stable. Speculum examination revealed a 2 × 1-cm soft, bluish mass bulging at the external os (Fig. 1). The upper extent of the mass could not be ascertained. The cervix was ballooned out. No active bleeding was noted. Transvaginal ultrasound revealed an empty uterus and a single live pregnancy with a crown-rump length of 8 weeks and cardiac activity in the cervix (Fig. 2). The internal os was closed. A serum beta human chorionic gonadotropin (hCG) level >150,000 mIU/mL was measured. Ultrasound-guided intracardiac injection of KCl into the ectopic pregnancy was performed, and 4 doses of systemic injection methotrexate with leucovorin rescue were administered. No drop in serum beta hCG level ensued. Subsequently, the patient experienced a bout of heavy bleeding. Evacuation of the products of conception was performed, followed by gentle curettage and then tight packing of the cervix and vagina with roller gauze. Estimated blood loss was 800 mL, and 1 unit of packed red blood cells was transfused. The pack was removed after 24 hours, at which point examination revealed a healthy-appearing cervix, with no evidence of retained products. Ultrasound confirmed an empty uterus and cervix. The patient experienced no further bleeding, and her serum beta-hCG level was 1200 mIU/mL at 1 week after the procedure. Fig. 2Ultrasound showing an empty uterus and a closed internal os in a cervical ectopic pregnancy of 8 weeks with cardiac activity in the anterior lip and an empty cervical canal. View Large Image Figure Viewer Download Hi-res image