Twin cervical ectopic pregnancy

Abstract

A 40‐year‐old woman presented for IVF treatment due to 8 years of secondary infertility. Two embryos were transferred without ultrasound guidance. The patient presented at 6.5 weeks gestation with heavy vaginal bleeding. A transvaginal ultrasound revealed twin cervical ectopic pregnancies, lying side by side in the cervical canal and within 6 mm of the external os. One contained a 9‐mm embryo with a normal fetal heart rate. The other sac was anembryonic. The bHCG level was 129 000 IU/L. The patient was treated with the same regimen of methotrexate as used for persistent trophoblast disease: second daily methotrexate with folinic acid rescue after each dose. Complete resolution of the twin pregnancy occurred, bleeding was however, recurrently heavy over the next 6 weeks.Discussion: Cervical ectopic pregnancy is a rare event, accounting for less than 1% of ectopic pregnancies. The incidence is increasing due to the increased use of in vitro fertilization. Prior to the advent of conservative treatments most patients required hysterectomy due to severe, uncontrollable bleeding. Conservative measures include dilatation and curettage (usually combined with uterine artery embolization, ligation or cervical balloon tamponade); local injection of methotrexate or potassium chloride (ultrasound guided); or systemic methotrexate. Twin cervical pregnancy is an extremely rare event with only two previous case reports in the literature [1]. Due to the large size of this twin pregnancy mass, the high bHCG level and the large volume of vascular trophoblast; we decided to treat this patient in a similar manner to a patient with gestational trophoblast disease. This mode of treatment should be considered with cervical ectopic pregnancies where the bHCG level is abnormally elevated.