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Incidental Cervical Carcinoma Causing Obstructed Preterm Labor at 23 Weeks: A Case Report
Nada Douraidi1, Soukaina Mouiman1, Meryem Abbouch1
1Gynecology-Obstetrics and Endoscopy, Maternity Souissi, University Hospital Center Ibn Sina of Rabat, Rabat, MAR.
Cervical cancer may remain undiagnosed during pregnancy in the absence of antenatal care, with potentially catastrophic obstetric consequences. We report an exceptionally rare case of an undiagnosed 5 cm cervical carcinoma discovered at 23 weeks of gestation, simultaneously obstructing the birth canal and complicated by chorioamnionitis-induced maternal sepsis. A 35-year-old multiparous woman (gravida 5 para 4) with a one-year history of uninvestigated post-coital metrorrhagia and no antenatal care presented at 23 weeks and 2 days with fever, pelvic pain, and watery vaginal discharge. Examination revealed sepsis with hemodynamic instability and a 5 cm indurated cervical mass with purulent leukorrhea; transvaginal ultrasound confirmed birth canal obstruction by the mass. An emergency cesarean section was performed, and a male neonate of 400 grams was delivered, dying two hours after birth from extreme prematurity. Cervical biopsies confirmed grade 2 squamous cell carcinoma (SCC); the patient was staged as International Federation of Gynecology and Obstetrics (FIGO) IIB and scheduled for radical hysterectomy and adjuvant chemoradiation. A cervical tumor can simultaneously obstruct labor and act as a nidus for ascending intrauterine infection, a dual mechanism not previously described. This case underscores the need for routine antenatal cervical examination and the urgent establishment of a national cervical cancer screening program aligned with international recommendations.
Cervical cancer may remain undiagnosed during pregnancy in the absence of antenatal care, with potentially catastrophic obstetric consequences. We report an exceptionally rare case of an undiagnosed 5 cm cervical carcinoma discovered at 23 weeks of gestation, simultaneously obstructing the birth canal and complicated by chorioamnionitis-induced maternal sepsis. A 35-year-old multiparous woman (gravida 5 para 4) with a one-year history of uninvestigated post-coital metrorrhagia and no antenatal care presented at 23 weeks and 2 days with fever, pelvic pain, and watery vaginal discharge. Examination revealed sepsis with hemodynamic instability and a 5 cm indurated cervical mass with purulent leukorrhea; transvaginal ultrasound confirmed birth canal obstruction by the mass. An emergency cesarean section was performed, and a male neonate of 400 grams was delivered, dying two hours after birth from extreme prematurity. Cervical biopsies confirmed grade 2 squamous cell carcinoma (SCC); the patient was staged as International Federation of Gynecology and Obstetrics (FIGO) IIB and scheduled for radical hysterectomy and adjuvant chemoradiation. A cervical tumor can simultaneously obstruct labor and act as a nidus for ascending intrauterine infection, a dual mechanism not previously described. This case underscores the need for routine antenatal cervical examination and the urgent establishment of a national cervical cancer screening program aligned with international recommendations.
