Modification of conservative treatment of heterotopic cervical pregnancy by Foley catheter balloon fixation with cerclage sutures at the level of the external cervical os: a case report

Tomislav Hafner,Berivoj Miskovic,Sanja Vujisic,Alan Serman,Renato Bauman,Boris Ujevic,Ivana Erceg Ivkosic,Daria Hafner

doi:10.1186/1752-1947-4-212

Abstract

IntroductionConservative treatment of a heterotopic cervical pregnancy was performed with a modification of the fixation of a Foley catheter at the level of the external cervical os, followed by the ligature of the descending cervical branches of the uterine arteries and systemic methotrexate application.Case presentationA 34-year-old Caucasian woman was diagnosed with double gestation after 6 weeks of in vitro fertilization treatment. A gynecological examination and color Doppler ultrasound scan revealed intra-uterine and cervical gestational sacs both containing live fetuses. A Foley catheter balloon was inserted into the cervical canal, inflated and fixed by a cerclage suture at the level of the external cervical os, followed by ligation of the descending cervical branches of the uterine arteries. Systemic methotrexate was applied. Three days after removal of the Foley catheter, an evacuation of the intra-uterine gestational sac was performed. Hemorrhage from the implantation site was controlled immediately and a pregnancy termination was successfully performed. The procedure was uneventful and our patient was discharged with a preserved uterus.ConclusionsConservative treatment of cervical pregnancy using a Foley catheter balloon is more efficacious if the Foley catheter balloon is attached in the correct position with a cerclage suture at the level of the external os, followed by ligation of the descending cervical branches of the uterine arteries, thereby exerting maximal pressure on the bleeding vessels.

Highlights

Conservative treatment of a heterotopic cervical pregnancy was performed with a modification of the fixation of a Foley catheter at the level of the external cervical os, followed by the ligature of the descending cervical branches of the uterine arteries and systemic methotrexate application.Case presentation: A 34-year-old Caucasian woman was diagnosed with double gestation after 6 weeks of in vitro fertilization treatment
Conservative treatment of cervical pregnancy using a Foley catheter balloon is more efficacious if the Foley catheter balloon is attached in the correct position with a cerclage suture at the level of the external os, followed by ligation of the descending cervical branches of the uterine arteries, thereby exerting maximal pressure on the bleeding vessels
The first report of an ectopic pregnancy following in vitro fertilization-embryo transfer (IVF-ET) was published in 1976, and subsequently cases have been reported at an increasing rate with an incidence of 0.25% to 1.4% of all pregnancies [2]

Summary

Conclusions

A combined intra-uterine and cervical pregnancy is a very rare but possible event, after ART, with a high risk of life-threatening hemorrhage; the only option may be to perform a life saving hysterectomy, thereby representing a diagnostic and therapeutic challenge. Conservative management of HP is effective and safe, and made possible by the use of multiple conservative modalities. If available, a conservative treatment of HP with a tamponade of cervical pregnancy by a Foley catheter balloon, slightly modified with a cerclage suture's fixation of the Foley catheter at the level of external cervical os, since it can be safely used without any major complication and combined with other conservative methods if required. Authors' contributions HT and SA analyzed and treated the patient. BR and BU performed the ultrasound examination of the patient. All authors read and approved the final manuscript.

Introduction

Findings

Discussion