Rare Case of Cervical Ectopic Pregnancy:

Objective:

To raise the awareness about cervical ectopic pregnancy and to emphasize the importance of differentiating cervical ectopic from cervical retained product of conception.

 

Case Report:

A-29- years old woman, G2P0 (1x termination of pregnancy) presented to emergency department at ~4 weeks gestation with history of painless vaginal bleeding. She was hemodynamically stable. BHCG was 2,378 and Hb was 121. Initial pelvic ultrasound revealed complex fluid in cervical canal suggestive of incomplete miscarriage with no evidence of extra uterine pregnancy. Follow up ultrasound in 2 days shows sac within the cervical canal of 8 mm in diameter surrounded by echogenic rim. No fetal pole, yolk sac or free fluid was identified. The findings were in keeping with cervical ectopic pregnancy with a possibility of differential diagnosis of incomplete miscarriage. Speculum examination showed odematous barrel shape cervix with no major bleeding. She was treated with a combination of systemic and intra lesional Methotrexate 24 hrs apart. A follow up comprised of serial BHCG done on days 0, 4,7 and weekly thereafter until negative. There was a successful drop in BHCG of 25% on day 7.

 

Discussion:

Cervical ectopic refers to a pregnancy that implants in the cervical tissue of endocervical canal. It accounts for <1% of ectopics. Risk factors for cervical ectopic are the same as for other ectopics. 70% of cervical ectopic cases were found to have a preceding history of dilatation and curettage. There is high risk of haemorrhage and hysterectomy with cervical ectopic. The most common presentation is profuse painless vaginal bleeding. Bimanual examination should be avoided. The treatment of choice is Methotrexate either systemic or intra sac injection or combination as in this case. The reported success rate of Methotrexate is 80-90%. Surgery is reserved for cases with failed Methotrexate or with severe haemorrhage. Endocervical curettage has a high risk of sever bleeding and hysterectomy.

 

 

Conclusion:

Cervical ectopic pregnancy is a rare but a potentially life threatening condition. Consideration of cervical ectopic as a differential diagnosis in cases of painless vaginal bleeding with suggestive ultrasound findings is essential for early diagnosis and prompt intervention.