Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

A case report of missed abortion in cervical pregnancy

Author
Tayebeh Naderi
Department of Obstet . and Gynecol Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Naturally, blastocyte implants in the uterine cavity. Implantation of blastocyst in any other place is considered an ectopic pregnancy, which is in more than 95% a tubal pregnancy. Cervical ectopic pregnancy is a rare type of ectopic pregnancy in wich blastocyte is implanted in the cervical canal. Therefore due to serious risks of cervical pregnancy, all obstetricians facing first-trimester vaginal bleedings should consider it as a differential diagnosis. In this article a case report of missed cervical pregnancy in a 32-year old woman is presented. The patient complained of temporary vaginal bleeding during the last 25 weeks. Sonography had been performed twice; the first one in the 12th week of gestation showing no fetal echo and the second in 22nd week of gestation showing a 27×12 mm mass and fluid in the endometrium. With the diagnosis of missed abortion suction curettage was performed at 25th week of gestation and it was lead to laparatomy due to active hemorrhage and clinical picture of deterioration of vital signs. During laparatomy, a dilated cervix completely invaded by throphoblasts was observed. Hysterectomy was performed with ovarian preservation as a final management. Pathologic findings showed complete implantation of placenta in the end cervix.
Keywords
Cervical pregnancy
Ectopic pregnancy
Hystroscopy
Missed abortion
Giambanco L., Chianchiano N., Palmeri V., Catalano G. Cervical pregnancy: an obstetric emergency.Minerva Ginecol. 1998;50(7-8):321-324.
Thomas G., Stovall Marian L., Mccord. Early pregnancy loss and ectopic pregnancy. In Jonathan S., Berek (Eds). Novak’s Gyneocology. 12th Edition., Baltimor, Philadelphia, Williams & Wilkins. 1997;PP511-512.
Cunningham F.G., MacDonald P.C., Gant N.F. Williams obstetrics. 21th Edition, USA, Appleton and Lange. 2001.
Pastorelli G., Steiner R., Haller V. Cervical pregnancy. Gyn Geburtshifliche Rundsch. 1997;34(4):209-215.
Thomas R.L., Gingold B.R., Gallagher M.W. Cervical pregnancy: a report of two cases. J Reprod Med Obs Gyn. 1991;36(6):459-462.
Stovall G.T., Ling W.F. Extra uterine pregnancy, clinical diagnosis and management. 1st Edition. USA, McGraw-Hill. 1993;PP162-164,289-291
Aust N.Z.J. Cervical pregnancy successfully treated with a sequential combination of methotrexate and mifepriston. Obs Gyn. 2002; 42(2):211-3.
Jeong E.H., Kim Y.B., Ji I.W., Kim H.S. Triplet cervical pregnancy treated with intraamniotic methotrexate. Obs Gyn. 2002;100(5S): 1117-1119.
Chew S., Anadakumar C. Medical management of cervical pregnancy a report of two cases. Singapore Med J. 2001;42(11):537-9.
Melilli G.A., Cormio G., Putignano G., Loverro G., Selvaggi L. Successful treatment of cervical and simultaneous cervico-isthmic pregnancy with methotrexate. Clin Exp Obs Gyn. 2001;28(2):89-90.
Okeahialam M.G., Tuffnell D.J., O’Donovan P., Sapherson D.A. Cervical pregnancy managed by suction evacuation and ballon tamponade. Eur J Obs Gyn Reprod Biol. 1998;79(1):89-90.
Mashiach S., Admon D., Oelsner G., Paz B., Achiron R., Zalely. Cervical shirodkar cerclage may by the treatment modality of choice for cervical pregnancy. Hum Reprod. 2002;17(2): 493-6.
Habek D., Habek J.C., Curzik D. Unrecognized cervical pregnancy treated by suction curettage and cervicovaginal tamponad. Zentralbl Gynakol. 2002;124(3):184-5.
Bakri Y.N., Amri A., Abdul Jabbar F. Tamponade-balloon for obstetrical bleeding. Int J Gyn Obs. 2001;74(2):139-42.
Ryu K.Y., Kim S.R., Cho S.H., Song S.Y. Preoperative uterine artery embolization and evauation in the management of cervical pregnancy: report of two cases. J Korean Med Sci. 2001;16(6):801-4.
Tuncer R., Uygur D., Kis S., Kayin S., Bebitoglu I., Erkaya S. Inevitable hysterectomy despite conservative surgical management in advanced cervical pregnancy: a case report. Eur J Obs Gyn Reprod Biol. 2001;10:100(1):102-4.
Journal of Reproduction & Infertility
Volume 4, Issue 1
Winter 2003
Pages 70-74