Management of a cervical heterotopic pregnancy presenting with first trimester bleeding: a case report and review of the literature

Capsule:
We present a case of cervical heterotopic pregnancy that was managed successfully, and we review the existing literature on this topic.

Authors:
Vasiliki A. Moragianni, M.D., M.S., Benjamin D. Hamar, M.D., Colin McArdle, M.D., David A. Ryley, M.D.
Volume 98, Issue 1 , Pages 89-94, July 2012

Objective:
To report a rare case of a cervical heterotopic pregnancy resulting from intrauterine insemination (IUI) that presented with first-trimester bleeding.

Design:
Case report and literature review.

Setting:
Large university-affiliated infertility practice.

Patient(s):
A 40-year-old gravida 2 para 1 Asian woman at 7-3/7 weeks gestational age following clomiphene citrate/IUI for the treatment of secondary infertility presented with heavy vaginal bleeding for several days.

Intervention(s):
Transvaginal ultrasound on admission revealed a single live intrauterine pregnancy and a cervical gestational sac containing a nonviable embryo. The patient continued to have vaginal bleeding and 2 days later underwent removal of the cervical ectopic pregnancy tissue with ring forceps, as well as an ultrasound-guided intracervical Foley balloon and cerclage placement. The bleeding subsided, and 48 hours later the Foley and cerclage were removed.

Main Outcome Measure(s):
Pregnancy outcome.

Result(s):
The remainder of the pregnancy was uncomplicated and the patient had a full-term cesarean delivery for footling breech of a healthy male infant.

Conclusion(s):
Cervical heterotopic pregnancy is a very rare event that almost universally results from infertility treatment. We present a case where we were able to remove the cervical ectopic and tamponade the bleeding, thus preserving the intrauterine pregnancy for this subfertile couple, and we review the existing literature.

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