A Rare Clinical Conundrum: Cervical Ectopic Pregnancy in the Presence of a Large Cervical Fibroid

Cervical ectopic pregnancy is a rare and potentially life-threatening condition, often presenting with irregular vaginal bleeding and a palpable cervical mass. The coexistence of cervical fibroids further complicates the diagnosis and management. A 29-year-old woman, P₄L₄, presented with a history of three months of irregular and heavy vaginal bleeding. She also reported recurrent urinary tract infections and difficulty in passing urine for the past two years. On per abdominal examination, the uterus was enlarged to 20 weeks of gestation. Transvaginal ultrasound showed a cervical ectopic pregnancy of nine weeks and six days of gestation in the presence of a large cervical fibroid. The patient underwent emergency laparotomy with a total hysterectomy. Intraoperative findings included a highly vascular, 20-week-sized uterus and a gestational sac located in the posterior lip of the cervix. Considering rarity and possible untoward events, the case was taken under general anesthesia. Severe bleeding complicated the management, requiring internal iliac artery ligation. The patient's postoperative course was uneventful, and she was discharged on day 5. This case report highlights the challenges in diagnosing and managing a cervical ectopic pregnancy complicated by a large cervical fibroid.