The Surgical Management of Cervical Ectopic Pregnancy: A Case Report

Abstract

Introduction. Cervical pregnancy is a rare type of ectopic pregnancy, and it represents <1% of all ectopic pregnancies. Case report. A 37-years-old third time pregnant woman sought medical attention due to the bloody discharge at 6 weeks of gestation. Patient was referred to the perinatology center where the decision to continue the pregnancy was made. However, the doctor supervising the pregnancy decided to re-refer her to another perinatology center (LUHS hospital Kaunas Clinics), where the ectopic cervical pregnancy with deep myometrial implantation was diagnosed. The total abdominal hysterectomy with pregnancy termination was performed due to the high risk of massive bleeding. To avoid this perioperative complication, embolization of both uterine arteries was performed before the operation. Four days after, due to severe abdominal pain and inability to reject the diagnosis of peritonitis caused by perforation of hollow organ, relaparotomy was performed. Perforation was not detected, however, 300 ml of serohemorrhagic fluid and a vaginal cuff abscess were found. Persistent abdominal pain was interpreted as dynamic intestinal obstruction for which symptomatic treatment was successful. The patient was released home 19 days after operation. Discussion. The method of treatment depends on the duration of the pregnancy, the serum βhCG concentration, the presence or absence of fetal heart function, the intensity of the bleeding and the patient's willingness to preserve fertility. As the duration of pregnancy prolongs, the risk of massive bleeding increases proportionately. Consequently, conservative management of the ectopic pregnancy becomes ineffective, and hysterectomy is usually performed. Conclusions. The abdominal hysterectomy can be performed successfully for treatment of cervical ectopic pregnancy when conservative treatment with methotrexate or minimally invasive treatment using the embolization of uterine arteries or uterocervical abrasion followed by the Foley catheter tamponade were unsuccessful or cannot be performed