Conservative treatment of cervico-isthmic heterotopic pregnancy by fine needle aspiration for selective embryo reduction

Heterotopic pregnancy is a life-threatening condition. A recent case at our institution prompted a systematic review of the literature from 2005 to 2010. In the majority (71%) of cases reviewed, risk factors for a heterotopic pregnancy were present. However, in several instances (33%), previous sonographic reports of a normal intrauterine pregnancy gave false reassurance. These results highlight the complexity of diagnosis. In addition, our findings were compared with two previous reviews covering cases from 1971 to 2004. This comparison highlighted two important trends: first, the increasing role of ultrasound in the definitive diagnosis of a heterotopic pregnancy, and second, the development of conservative approaches to management. Medical knowledge and technology may be improving, but ultimately, even in the presence of a known intrauterine pregnancy, the simple dictum 'think ectopic' must not be forgotten.

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Cervical ectopic pregnancy after in vitro fertilization: case report successfully treated with cervical electric aspiration

Drezett

Marques

Ottoboni

et al. 2019

JBRA Assisted Reproduction

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Cervical ectopic gestation is a serious and potentially lethal condition considered exceptional in in vitro fertilization. Early diagnosis is critical to successful treatment and preservation of fertility. We report a rare case of cervical pregnancy after in vitro fertilization and embryo transfer, successfully treated exclusively with electrical aspiration. Case report: A 36-year-old patient attended the Department of Human Reproduction at Pérola Byington Hospital in 2015 due to primary infertility with no apparent cause for seven years. Subjected to ovulation induction with recombinant depot FSH and GnRh analogue, triggered with chorionic gonadotropin. It evolved with the collection of ten oocytes and transfer of two embryos, with cryopreservation of the remaining ones. The control with serial ultrasound showed a gestational sac in uterine cervix topography, indicating gestation of six weeks, confirmed after 24 hours by a second operator. The treatment was successfully performed by electric aspiration with an EasyGrip® cannula of 6 mm in diameter, without the occurrence of hemorrhage or the need for other procedures. Early diagnosis allowed successful conservative treatment with only cervical aspiration. The literature review confirms the rarity of the case, but does not indicate consensus on the best treatment of cervical ectopic pregnancy.

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Conservative treatment of cervico-isthmic heterotopic pregnancy by fine needle aspiration for selective embryo reduction

Abstract: An unusual case of a heterotopic cervico-isthmic pregnancy after IVF treatment occurred in a 34-year-old woman. Transvaginal ultrasound-guided aspiration of the gestational sac for embryo reduction was safely used to manage the pregnancy and preserve the intrauterine fetus.

Cited by 3 publications

References 9 publications

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Heterotopic pregnancy

Cervical ectopic pregnancy after in vitro fertilization: case report successfully treated with cervical electric aspiration

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