Hysteroscopic removal of a heterotopic cervical pregnancy to preserve a patient’s intrauterine sac

Abstract

To introduce a case of removing the heterotopic cervical pregnancy while preserving the normal gestational sac in the uterine cavity by hysteroscopic surgery under ultrasound guidance. Video description of the case and surgical procedure. Hospital affiliated to university. A 35-year-old woman, G7P1A5L1, was admitted with a heterotopic cervical pregnancy 21 days after IVF-ET (the corrected gestational age was 5+2 weeks). The serum β-hCG level was 24,530.00 mIU/ml at the corrected gestational age of 5+3 weeks. The ultrasound examination on the day of admission showed that there was a gestational sac in the cervical canal (1.5×0.8×0.5 cm, yolk sac visible) and another sac in the intrauterine cavity (1.2×1.2×1.1 cm, yolk sac visible). The pregnant woman and her partner strongly urged the removal of the cervical gestational sac and continuing the intrauterine pregnancy to term. After the Institutional Review Board (IRB) approval was obtained, hysteroscopic surgery with bipolar resectoscope and transabdominal ultrasound guidance was used to resect the heterotopic cervical pregnancy while preserving the intrauterine gestational sac. The heterotopic cervical pregnancy was completely resected by hysteroscopy, and the normal gestational sac in the uterine cavity was successfully preserved. Ultrasound-guided hysteroscopic surgery allowed us to successfully preserve the intrauterine pregnancy while removing the cervical pregnancy completely. During the operation, the dilation pressure and the flow rate of the dilation fluid was kept as low as possible to avoid excessive intrauterine pressure and excessive dilation fluid entering the intrauterine cavity, which could have had adverse effects on the intrauterine pregnancy sac. No surgical-related or anesthesia-related complications occurred. The pathological results confirmed placental villi and decidual tissue. The One-month follow-up ultrasonography showed a live single intrauterine pregnancy with cardiac activity. Hysteroscopic removal of a heterotopic cervical pregnancy under ultrasound guidance can be safely performed while successfully preserving an ongoing intrauterine pregnancy.