Ultrasound findings and presenting symptoms in cervical ectopic pregnancy

Abstract

OBJECTIVE: To describe the ultrasound findings and signs and symptoms at presentation in patients with cervical ectopic pregnancy (CEP). DESIGN: Retrospective case series. MATERIALS AND METHODS: We identified patients with CEP treated between January 2000 and December 2008 at Hutzel Women's Hospital in Detroit, Michigan. Chart review was performed and abstracted data included patient's demographics, presenting symptoms, laboratory and ultrasound findings and risk factors for CEP. Whether CEP was initially misdiagnosed was documented. RESULTS: 14 patients with CEP were treated during the study period, one of which was a heterotopic pregnancy. 8 patients presented to the emergency department (ED), 4 were transferred from other hospitals and 2 were directly admitted from clinic. Patients' age ranged from 21 to 41 years. All but one were multigravid, and 10 patients had at least one risk factor for CEP (e.g. termination of pregnancy, cesarean section or cervical cone). Gestational age ranged from 5 to 11 weeks and B-hCG from 3,039 to 271,488 IU/ml. The main presenting symptom was vaginal bleeding: mild bleeding in 7 patients, moderate in 4 and heavy with the passage of clots in 3. Six patients had experienced abdominal pain or cramping. Transvaginal ultrasound findings were consistent with gestational age in all patients. A gestational sac (GS) and yolk sac were present in all cases and fetal heart activity was detected in 9. The distance between the external cervical os and the leading edge of the GS ranged from 7 to 25 mm. 6 of the 8 patients who presented to the ED were misdiagnosed and discharged home. In those patients, CEP was diagnosed on follow-up ultrasound. The most common misdiagnosis was threatened abortion. CONCLUSIONS: Patients with cervical ectopic pregnancy present with a common symptom of vaginal bleeding. Except for gestational sac location, the ultrasound findings are similar to those of intrauterine pregnancy. Caution should be paid not to confuse cervical ectopic pregnancy with threatened abortion.