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The modern gynecologist needs to be aware of the possibility of cervical ectopic pregnancy, since interventions like dilatation and curettage performed for an incomplete abortion can be catastrophic.
A 19 year-old female patient, gravida 1 para 0, pregnant at 9 weeks gestation presented with vaginal bleeding. Her Serum beta-hcg was 4331 mIU/ml and pelvic examination revealed a dilated cervix up to 3 cms, with moderate amount of vaginal bleeding. She had no previous scans in the pregnancy so far. She had no previous history of cervical surgeries or infections. A diagnosis of incomplete abortion was considered. Her transvaginal scan revealed a cervical ectopic pregnancy.
Typical features of cervical ectopic pregnancy on ultrasound are- An empty uterine cavity noted on the ultrasound, with a much distended cervix.
A figure of eight appearance of uterus seen on the ultrasound due to constricted internal os of the cervix, distinguishing cervical ectopic gestation from an incomplete abortion(Figure).
A 3 D image of the uterus and cervix, depicting empty endometrial cavity and a dilated cervix with hour glass appearance.
Cervical pregnancy is a very rare form of ectopic pregnancy and mostly confused with an incomplete abortion, with products of conception in the process of expulsion. It is more commonly seen in multiparous females, with history of recurrent curettages or cesareans. A differential diagnosis of cervical ectopic should be considered in any female with these risk factors. Treatment options include multiple doses of intramuscular Methotrexate, uterine artery embolization, intracervical vasopressin injection, balloon tamponade of implantation site after evacuation. These treatment methods can be combined with a dilatation and curettage. Dilatation and curettage should be undertaken very carefully in these patients since a sharp curettage can result in extensive hemorrhage leading to an emergency hysterectomy.
The modern gynecologist needs to be aware of this condition since interventions like dilatation and curettage performed for an incomplete abortion can be catastrophic and a physician may be caught unaware if diagnosis of cervical ectopic is not considered.
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