Cervical ectopic pregnancy, conservative management. Clinical case report

Abstract

Introduction: Ectopic pregnancy is defined as the implantation of the zygote outside the uterine cavity such as the fallopian tube, ovary, abdominal organs, or cervix. The implantation at the level of the internal cervical os or below is considered a cervical ectopic pregnancy. Corresponding to an unusual type, with an incidence of 1 in 2500 to 98000 pregnancies. It is an extremely dangerous and potentially fatal condition, where the trophoblast can reach the uterine vessels through the cervix producing massive bleeding. In the past, the diagnose was commonly incidentally. Performed during curettage of a suspected incomplete abortion, associated with uncontrollable bleeding resulting in a hysterectomy. Nowadays, ultrasound and early diagnosis allow treating the patient with conservative pharmacological management or surgical techniques, avoiding hysterectomy, and preserving fertility.

Objective: Describe a clinical case of cervical ectopic pregnancy treatedwith conservative management.

Material and methods: Retrospective descriptive study, clinical case report.

Results:Clinical case of a 37-year-old nulliparous female patient, with a second pregnancy of 7.6 weeks and history of abortion.Attending to obstetric gynecological emergencies, due to abdominal pain and vaginal bleeding.The ultrasound examination detected a63.9 mm cervix, occupied by an irregular gestational sac of 42.89 mm containing a 12.1 mm embryo with cardiac activity.Confirming the diagnosis of cervical ectopic pregnancy.Therefore, it was decided to start conservative management with intramuscular methotrexate of 61mg on days 1,3,5 and 7 and intravenous folinic acid of 6.1mg on days 2,4,6 and 8. Ultrasound examination was performed, manifesting therapeutic failure. Considering the patient's wish to preserve fertility, she was treated with an intrassacular injection of potassium chloride, inserting 1 mm of the needle provoking bleeding. The patient was transferred to the operating room, where the cervical arteries were clamp and manual vacuum aspiration was performed under ultrasound guidance. A Bakri balloon was placedto control bleeding, preventing hysterectomy.

Conclusions: Cervical ectopic pregnancy is a rare and dangerous type of pregnancy. An early ultrasound detection permits pharmacological and surgical treatment using conservative management, avoiding hysterectomy.