EP24.13: Cervical ectopic pregnancy: case series of 6 cases

Abstract

A “cervical pregnancy” is an ectopic pregnancy that has implanted in the uterine endocervix. It typically aborts within first trimester, however, if it is implanted closer to the uterine cavity-so called cervicoisthmic pregnancy, it may continue longer. Placental removal in a cervical pregnancy may result in major hemorrhage. It can be confused with miscarriage as abortion in progress with sac passing through the cervix. Hence it is important to diagnose it correctly. We discuss the diagnostic features on ultrasound, importance of Colour Doppler in correct diagnosis and role of USG in follow up and treatment options in these cases. We analysed the ultrasound findings of cervical ectopic pregnancy in 6 cases. The study was performed on Phillips HD 11 XE & IU 22 ultrasound machine using C 5-2 convex & C 8-4 V transvaginal transducer. The size of gestational sac, trophoblastic reaction and vascularity, presence of embryo, its cardiac activity if present was documented. The gestational age at diagnosis was 6-9 weeks. All 6 cases showed empty endometrial cavity, closed internal os, three cases showed presence of only gestational sac (without fetal pole) with trophoblastic vascularity, three showed presence of embryo within sac; two with cardiac activity and one without cardiac activity. Five patients underwent curetting. One live ectopic was treated with methotrexate first and curetting was done later. Another live ectopic was treated with KCl injection for fetal reduction and then curetting was done. One was treated with methotrexate, patient started bleeding on 3rd day and aborted completely. A cervical ectopic pregnancy is a very rare form of extrauterine pregnancy. Its correct diagnosis helps in timely intervention. Surgical evacuation of the pregnancy alone is not recommended because the cervix is unable to contract and prolonged bleeding may follow. Hence expectant management with methotrexate is recommended in non-emergency cases. USG as imaging modality not only helps in diagnosis but also in follow up if it's treated on methotrexate.