Management of cervical ectopic pregnancy with uterine artery embolization: a case report

Cervical ectopic pregnancy is a rare occurrence but carries the risk of life-threatening maternal hemorrhage.

A 35-year-old woman, gravida 4 para 2, presented to the Emergency Room with the complaint of pelvic cramping and vaginal spotting. Initial quantitative serum beta-hCG value was 79,506.7 mIU/mL. Obstetrical ultrasound demonstrated a single, live pregnancy of approximately 8 weeks' gestation located within the endocervical canal. Pelvic MRI confirmed a live cervical ectopic pregnancy. Following discussion of management options, the decision was made to employ uterine artery embolization (UAE). Subsequent to UAE and by hospital day 4, no embryonic cardiac activity was noted. Postdischarge day 12 gynecologic ultrasound demonstrated a small, complex endocervical fluid collection compatible with resolving cervical pregnancy.

If clinical circumstances are amenable to trial of embolization, interventional radiology should be consulted for cervical ectopic pregnancy management. In cases in which there may be relative contraindications to methotrexate therapy alone and there is desire to avoid hysterectomy, clinicians should give consideration to a combination of strategies, including UAE, to manage cervical pregnancy. The case report highlights a review of the current literature and discusses options for conservative cervical ectopic pregnancy management.