Successful resection of a cervical pregnancy with original diagnosis of bladder wall invasion and rupture potential
Wei-Min Hu1, Ming-Jie Yang, Kuan-Chong Chao
1Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan.
Objective:
Cervical pregnancy is a rare life-threatening form of ectopic pregnancy. In the past, hysterectomy was often the only choice available because of profuse hemorrhage that accompanied the attempts of removal of the cervical pregnancy.
Case Report:
We present a case of a successful surgical resection of a cervical pregnancy. Diagnosis of a viable cervical pregnancy was made at 9 weeks by ultrasound. Acute abdominal pain, massive vaginal bleeding, and impending shock occurred suddenly in this patient. In order to preserve her future fertility, we used a series of modified procedures, step-by-step, to minimize and control acute hemorrhaging, including transient ligation of the cervicovaginal branches of the uterine vessels with an 18-Fr Foley catheter, vasopressin use, resection of the ectopic pregnancy mass, compression using a 24-Fr Foley catheter, and finally, wound closure. Intraoperative blood loss was less than 400 mL. This treatment was successful, with resumption of normal menstrual cycles and a normal transvaginal ultrasonographic appearance of the cervical canal documented 3 months after the initial diagnosis.
Conclusion:
The use of modified surgical procedures, step-by-step, is a good alternative to total hysterectomy for managing cervical pregnancies that require urgent attention.
