Background. Ectopic twin cervical pregnancy is a very rare condition with a high risk of heavy bleeding. Since currently no standard treatment guidelines are available, each case is approached individually based on patient preference, physician experience, and resource availability. Case presentation.A 34-year-old nulliparous Caucasian woman at 5 weeks gestational age presented with slight vaginal bleeding for several days. Transvaginal ultrasound on admission revealed two cervical gestational sacs containing a yolk-sac. The patient underwent removal of the cervical ectopic pregnancy with dilatation and curettage ultrasound-guided, as well as an ultrasoundguided intracervical Foley balloon. The bleeding subsided, and 48 hours later the Foley was removed.Conclusions. Twin cervical heterotopic pregnancy is a very rare event that almost universally results in life-threatening conditions. Conservative management may be adopted, but it involves a high risk of failure. The present systematic review aimed to increase awareness of clinical characteristics and treatment methods.