Cervico-Isthmic Pregnancy: Early Diagnostic Imaging and Successful Dual Therapy for Uterine-Sparing Treatment

Takeda, Akihiro; Koike, Wataru; Hayashi, Shotaro; Imoto, Sanae; Nakamura, Hiromi

doi:10.1016/j.jmig.2015.01.019

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…As the GS enlarges, it causes heavy bleeding, making it difficult to continue the pregnancy [ 5 , 6 ]. Cervico-isthmic pregnancy is considered to implant across the cervical canal and cervico-isthmus of the uterus between the histological and anatomical internal os [ 1 , 7 ]. In the present case, we detected the gradual insertion of the placenta into the cervix and cervical shortening with the progression of gestation.…”

Section: Discussionmentioning

confidence: 99%

“…Cervico-isthmic pregnancy is defined as a placenta that partially extends beyond the histological internal cervical os. Its incidence ranges between 1 in 1,000 to 95,000 pregnancies [ 1 , 2 ]. Cervico-isthmic pregnancy is often accompanied by placenta accreta, causing massive bleeding from the detached surface of the placenta at delivery, and most cases require hysterectomy [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Placental Insertion into the Cervix with Cervical Shortening as a Clinical Sign to Suspect Cervico-Isthmic Pregnancy: A Case Report and Literature Review

Ito

Suzuki

Amano

et al. 2023

Case Reports in Obstetrics and Gynecology

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The clinical signs of cervico-isthmic pregnancy during pregnancy remain unknown. We herein report a case of cervico-isthmic pregnancy showing placental insertion into the cervix with cervical shortening, with a final diagnosis of placenta increta at the uterine body and cervix. A 33-year-old multiparous woman with a history of cesarean section was referred to our hospital at 7 weeks of gestation with suspected cesarean scar pregnancy. Cervical shortening with a cervical length of 14 mm was noted at 13 weeks of gestation. The placenta is gradually inserted into the cervix. An ultrasonographic examination and magnetic resonance imaging strongly suggested placenta accreta. We planned elective cesarean hysterectomy at 34 weeks of gestation. The pathological diagnosis was cervico-isthmic pregnancy with placenta increta at the uterine body and cervix. In conclusion, placental insertion into the cervix with cervical shortening in the early pregnancy period may be a clinical sign to suspect cervico-isthmic pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Placental Insertion into the Cervix with Cervical Shortening as a Clinical Sign to Suspect Cervico-Isthmic Pregnancy: A Case Report and Literature Review

Ito

Suzuki

Amano

et al. 2023

Case Reports in Obstetrics and Gynecology

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“…Cervico-isthmic pregnancy (CIP) is a rare and potentially life-threatening ectopic pregnancy in which the fertilized egg implants in the isthmus between the histological and anatomical internal os. The internal cervical os is defined histologically as the transition area from the endocervical mucosa to the isthmic mucosa and anatomically as the transition area between the isthmus and uterine corpus [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

New paradigm for cervico-isthmic pregnancy: conservative management of cervico-isthmic pregnancy leading to successful deliveries

Bae

2023

Obstet Gynecol Sci

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To establish a new treatment option for cervico-isthmic pregnancy (CIP) other than termination by maintaining pregnancy from diagnosis to delivery. MethodsThis retrospective observational study included women diagnosed with CIP at Dongsan Medical Center, Daegu, Korea, from January 2014 to December 2019. Eight patients were diagnosed with CIP using transvaginal ultrasound and met the following inclusion criteria: (1) preserved and closed cervical canal; and (2) more than half of the uterine cavity above the sac was not involved in sac implantation. Five of the eight mothers decided to maintain their pregnancy after an adequate explanation of the possible risks. The same sonographer assessed fetal and maternal status every 1-2 weeks. Intra-and postoperative indicators, delivery information, and neonatal outcomes were also recorded. ResultsThe mean patient age was 36 years. In all cases, placenta accreta spectrum and placenta previa were detected using preoperative ultrasonography. A hysterectomy was performed in three cases, and all patients required intensive care unit (ICU) care. The mean operative time was 156 minutes. The rate of postpartum hemorrhage was 40%. Four viable fetuses were delivered. Birth preceding 34 weeks occurred in one patient, who required neonatal ICU hospitalization for 19 days. ConclusionConservative treatment with careful diagnosis, management, and sufficient consultation could be an alternative treatment option in women with CIP, particularly older mothers, those with subfertility, and those who expect to have limited future opportunities for a successful pregnancy. Therefore, CIP should be treated as a separate disease entity.

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Successful fertility preservation by expectant management of a cervico-isthmic pregnancy with fetal death in the second trimester: A case report

Obata

Shindo

Otani

et al. 2023

Case Reports in Women's Health

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Cervico-Isthmic Pregnancy: Early Diagnostic Imaging and Successful Dual Therapy for Uterine-Sparing Treatment

Cited by 4 publications

References 18 publications

Placental Insertion into the Cervix with Cervical Shortening as a Clinical Sign to Suspect Cervico-Isthmic Pregnancy: A Case Report and Literature Review

Placental Insertion into the Cervix with Cervical Shortening as a Clinical Sign to Suspect Cervico-Isthmic Pregnancy: A Case Report and Literature Review

New paradigm for cervico-isthmic pregnancy: conservative management of cervico-isthmic pregnancy leading to successful deliveries

Successful fertility preservation by expectant management of a cervico-isthmic pregnancy with fetal death in the second trimester: A case report

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