Cervical ectopic pregnancy: one cause of first trimester pregnancy bleeding (a case report)

Back ground: Cervical pregnancy is a rare type of ectopic pregnancy that can be associated with significant hemorrhage and loss of fertility. (1) Its sonographic findings can be difficult to distinguish from normal pregnancy or an abortion in progress. (3) Most of the cervical pregnancies have been reported in patients with a history of vacuum curettage or caesarean section.(2) Given its rarity, most effective treatment protocols are not well established.(1)Case: A 30-year-old woman (Gravida4, Para2 Abortion 1) presented with history of painless vaginal bleeding. Her obstetric history included tow cesarean section and one curettage after previous abortion. Transvaginal ultrasonography showed 11week gestational sac measuring 52mm with fetal pole without cardiac activity, and with diagnosis of missed abortion, misoprostol was prescribed. Because of continued vaginal bleeding and no response to misoprostol, D&C was performed and due to sever vaginal bleeding during D&C that wasn’t controlled with Foley catheter balloon compression, total abdominal hysterectomy was done. The diagnosis was clarified by pathological examination that showed a cervical ectopic pregnancy.Conclusion: Cervical pregnancy is a rare form of ectopic pregnancy in which the blastocyst implants below the internal cervical os. (4) Risk factors include previous dilatation and curettage, intrauterine device use, previous cesarean section, congenital structural anomalies, large uterine fibroids, infection and inflammation, in vitro fertilization and advanced maternal age. (3) Nowadays it is still difficult to diagnose and challenging to treat (4). Treatment options depend on gestational age and the woman’s hemodynamic stability, usually involving more than one approach to minimize risks of massive hemorrhage and maintain fertility. These include D&C followed by a Foley catheter balloon compression of placental bed, uterine artery embolization followed by, or methotrexate, with or without subsequent D&C. Most second and third trimester cervical pregnancies are treated with hysterectomy. The keys to successful management are an early diagnosis, planned intervention and good control of bleeding.