Heterotopic cervical pregnancy after in-vitro fertilization - case report and
            literature review

Terra, Maria Eduarda Furtado Fernandes; Giordano, Luiz Augusto; Giordano, Mario; Sá, Renato Augusto Moreira de; Campos, Fernanda; Yadid, I.M.; Pinto, Felipe de Oliveira

doi:10.5935/1518-0557.20190017

Cited by 7 publications

(17 citation statements)

References 39 publications

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“…In recent years, the widespread application of uterine cavity operations such as induced abortion has increased the incidence of cervical pregnancy year by year, and the current incidence of cervical pregnancy accounts for 1% of ectopic pregnancies. The important component of the cervix is fibrous tissue, so the implantation of the fertilized egg in the cervix is not stable, and most patients will have a miscarriage within 20 weeks of pregnancy [ 2 , 3 ]. The gestational sac is surrounded by abundant blood vessels and will be at risk of hemorrhage in case of abortion.…”

Section: Introductionmentioning

confidence: 99%

Effect of Uterine Arterial Chemoembolization Combined with Ultrasound-Guided Uterine Curettage on Cervical Pregnancy and Influencing Factors

Gong¹,

Qian

Zhang³

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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This is a retrospective study to analyze the efficacy of uterine artery chemoembolization (UACE) combined with ultrasound-guided curettage in the treatment of cervical pregnancy and the factors affecting the postoperative outcome. A total of 26 subjects were included in the study and were divided into a control group of 12 and an observer group of 14, all patients with cervical pregnancy diagnosed in our hospital from January 2016 to January 2020. Patients in the control group were treated with methotrexate injection (MTX) combined with ultrasound-guided curettage in our hospital, while the observer group was treated with UACE combined with ultrasound-guided curettage. The efficacy of the two groups was evaluated at 3 months postoperatively, and data on patients’ age, days of menopause, pregnancy frequency, and vaginal bleeding were collected retrospectively. Intraoperative bleeding, time to recovery of serum human chorionic gonadotropin (HCG), hospitalization time, time to return to normal menstruation, time to disappearance of gestational sac, pregnancy frequency, presence of endometrial inflammation, gestational week, maximum diameter of gestational sac, thinnest myometrium, endogenous-exogenous type, gestational sac size, and HCG level were recorded in both groups. Single-factor analysis and multifactor logistic regression models were used to analyze the factors influencing the surgical outcomes of patients. The results of the study showed that the overall efficiency of the observer group was significantly higher than that of the control group, while intraoperative bleeding, hospital stay, time to return to normal menstruation, and time to disappearance of the gestational sac were all lower than those of the control group ( p < 0.05 ). The results of univariate and multifactorial analyses showed that endometrial inflammation, gestational week, maximum diameter of the gestational sac, thinnest myometrium, and endogenous-exogenous type could affect the patients’ postoperative recovery ( p < 0.05 ); gestational week, maximum diameter of the gestational sac, and thinnest myometrium were independent factors affecting the patients’ postoperative recovery ( p < 0.05 ). The above results suggest that UACE combined with ultrasound-guided uterine clearance for cervical pregnancy can significantly improve treatment efficacy, reduce intraoperative bleeding, and improve recovery time from postoperative related symptoms. The treatment efficacy of patients with cervical pregnancy was related to the gestational week, the maximum diameter of the gestational sac, and the thinnest muscle layer.

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Section: Introductionmentioning

confidence: 99%

Effect of Uterine Arterial Chemoembolization Combined with Ultrasound-Guided Uterine Curettage on Cervical Pregnancy and Influencing Factors

Gong¹,

Qian

Zhang³

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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show abstract

“…Currently, the reason why ART predisposes to abnormal implantation of the embryo at the cervical level is unknown, although it could be related to risk factors common to this type of patient (cervical abnormalities, history of previous curettage) as well as factors associated with the technique used in embryo transfer such as cervical lesion during the procedure, volume and viscosity of the transfer medium or reflux of the transferred embryo from the cavity to the cervix [5,8].…”

Section: Discussionmentioning

confidence: 99%

“…The cervical location of HP is very infrequent, and furthermore, it presents some specific characteristics. For example, patients usually begin with vaginal bleeding, present in up to 80% of the cases recently reviewed by Terra et al [5].…”

Section: Discussionmentioning

confidence: 99%

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A case of heterotopic pregnancy with intrauterine and cervical pregnancy coexisting: intrasacular KCl injection, intrauterine pregnancy being preserved, and then massive bleeding at 32 weeks

Sierra¹,

Romera²,

Luján³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Background: Heterotopic pregnancy is the condition in which intrauterine and ectopic pregnancy coexist. The conservative management of the ectopic pregnancy, with the intrauterine pregnancy preserved, has been reported. Case(s): Here, we report a very rare case: intrauterine and cervical pregnancy coexist: intrasacular Potassium chloride (KCL) injection successfully terminated cervical pregnancy with intrauterine pregnancy preserved, but later massive bleeding occurred from the cervix. A 39-year-old woman at 7 +1 weeks was diagnosed with a heterotopic cervical gestation, with intrauterine and cervical sac, both with live embryos. The ectopic pregnancy was successfully terminated with intrasacular injection of KCl, preserving the intrauterine pregnancy. At 32 +4 weeks of gestation the patient started with a profuse bleeding from the cervical sac, causing maternal hypotension (80/45 mmHg) and tachycardia (160 bpm) and a decelerative pattern in the cardiotocographic fetal monitoring, prompting us to perform caesarean section. The cessation of bleeding was achieved using a double balloon intracervical catheter, which was withdrawn 24 hours after its insertion without observing a new bleeding episode. The patient was discharged after 8 days and the newborn after 35 days of life, both in good health. Conclusions: Conservative treatment of a heterotopic gestation is possible, managing to preserve the viability of the intrauterine pregnancy.

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“…Cervical HP is particularly challenging given the rarity of the pathology, the lack of a consensus on treatment, and the high incidence of complications, particularly vaginal bleeding, which can lead to hysterectomy. A recent review which included 37 cases from 1989 to 2018 [ 3 ] reports that in 29, aiming at maintaining the IU pregnancy, 26, all treated with surgical excision with/without intra amniotic injection of KCl or methotrexate, resulted in live birth. However, only two women did not present complications at the time of the procedure or during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Successful Transvaginal Microwave Ablation of a Heterotopic Cervical Pregnancy. A Case Report

et al. 2020

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Heterotopic cervical pregnancy is a rare and potentially dangerous condition where the challenge is the removal of the ectopic pregnancy while preserving the intrauterine one. We present the case of an otherwise healthy 36-year-old woman with heterotopic cervical pregnancy after an IVF cycle for tubal infertility. At 6.5 weeks after a consultation with gynecologists and interventional radiologists, the patient agreed to undergo microwave ablation of the cervical pregnancy. Monthly ultrasound examination showed the persistence of non homogeneous and vascularized tissue in the cervix. Intrauterine pregnancy continued without complications until 37 weeks when a cesarean section was performed for sudden and profuse bleeding, in the presence of uterine contractions. A healthy baby girl was delivered, and the postoperative course was otherwise uncomplicated. Heterotopic cervical pregnancies are rare, and no consolidated and risk-free treatments are available at the moment. Here, we present a case of heterotopic cervical pregnancy treated successfully and without complications with microwave ablation.

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Heterotopic cervical pregnancy after in-vitro fertilization - case report and literature review

Cited by 7 publications

References 39 publications

Effect of Uterine Arterial Chemoembolization Combined with Ultrasound-Guided Uterine Curettage on Cervical Pregnancy and Influencing Factors

Effect of Uterine Arterial Chemoembolization Combined with Ultrasound-Guided Uterine Curettage on Cervical Pregnancy and Influencing Factors

A case of heterotopic pregnancy with intrauterine and cervical pregnancy coexisting: intrasacular KCl injection, intrauterine pregnancy being preserved, and then massive bleeding at 32 weeks

Successful Transvaginal Microwave Ablation of a Heterotopic Cervical Pregnancy. A Case Report

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