Successful pregnancy outcome following a previous conservatively managed cervical ectopic.

Dr Anisha Chakraborty,Dr Poonam Khera ,Dr Saloni Arora ,Dr Geetika Arora Bhatia,Dr Tanya Buckshee Rohatgi

Max Healthcare , MIME ,NEW DELHI

INTRODUCTION

Ectopic pregnancy is relatively common, but cervical ectopic pregnancy is rare, accounting for less than 1% of all cases. It carries a high risk of morbidity and can significantly impact future fertility.

CASE HISTORY

A 29-year-old primigravida with spontaneous conception was admitted with 5 weeks of amenorrhea and painless bleeding per vaginam.

She was hemodynamically stable with unremarkable abdominal examination . Local examination revealed bleeding at the level of external

os . On gentle per vaginam examination -there was ballooning of cervix , however the os was closed, with no tenderness. The ßHCG was

6937 miu/l.

Transvaginal sonography revealed a single gestational sac with yolk sac and fetal pole ,corresponding to 5 weeks 6 days in the cervical

canal just above the external os . No cardiac activity was seen. The external os was closed with absent sliding sign. These findings were

suggestive of cervical ectopic pregnancy.

After discussing with the patient ,both systemic and local management with methotrexate(MTX) was planned.Treatment began with an

intramuscular injection of 75 mg methotrexate (MTX) . The following day ,transvaginal ultrasound-guided intrasac injection of 60 mg MTX

using a 22G Chiba needle was given .An injection of folinic acid was given on day 3. By day 7,ßHCG fell to 4606 miu/ml and the patient

was clinically asymptomatic.

Follow up consisted of clinical assessments , regular ultrasound and serial ßHCG levels which showed a declining trend. Patient was

advised not to get pregnant for the next 6 months.

Patient conceived spontaneously 8 months later and had an uneventful pregnancy . A healthy , term baby was deliverd by caesarean

section on account of deep transverse arrest.