Cervical ectopic pregnancy at 22 weeks: A case with subsequent pregnancy outcome

Cervical ectopic pregnancies are rare ectopic pregnancies inherently associated with abnormal placentation. Fertility-sparing management of cervical ectopic pregnancy can have benefits for the patient, but such treatment strategies are less successful in the second trimester.

We report a case of fertility-sparing management of a cervical ectopic pregnancy at 22 weeks' gestation with a successful subsequent pregnancy. A misdiagnosis of threatened abortion on first-trimester ultrasonography delayed accurate diagnosis of the cervical ectopic pregnancy until 20 weeks' gestation. She desired future fertility and underwent intra-amniotic feticidal injection, planned uterine artery embolization, and classical hysterotomy to deliver the demised fetus. Adherent portions of the placenta were left in situ and bleeding was controlled with intracervical balloon tamponade. She underwent serial imaging throughout her postoperative, postpartum, and subsequent preconception course. Retained products completely resolved by 5 months after surgery. She conceived spontaneously 1.5 years later and had normal serial cervical length measurements. She delivered a healthy term infant via repeat Cesarean section.

Fertility-sparing treatment of cervical ectopic pregnancy at advanced gestational ages may require a multimodal approach including surgery due to the degree of fetal and placental development. Attention to specific first-trimester sonographic findings may help distinguish between cervical ectopic pregnancy and threatened abortion. Assessment of cervical retained product resolution and preconception ultrasound are important considerations in planning for subsequent pregnancy. Maternal fetal medicine consultation is recommended in subsequent pregnancies to assess placental location and screen for cervical insufficiency.