[Cervical pregnancy: an obstetric emergency. A clinical case]

Cervical implantation could develop in three different ways. The gestational sac can grow up to external os and interruption may simulate an abnormal menstruation. Theoretically the gestational sac could reach the uterine cavity, with a normal evolution of the pregnancy, even if the implantation of the placenta would be on internal uterine os. Lastly, the ectopic gestational sac developes all in cervical channel with an "obstetrical catastrophe". The incidence of cervical pregnancy presents great differences between authors, from 1:1,000 to 1:95,000 pregnancies; this is due to the variability of diagnostic criteria. A 36 year-old woman, para 1001, came to the emergency unit with painless vaginal bleeding. She was pregnant at 8 weeks of amenorrhoea, and previously undergone a cesarean section. The portio was swollen and bluewish, the external os was opened. The uterus was slightly increased, expecially in the peri-isthmic area; no adnexal mass. The urinary hCG was < 15,000 I.U. An ultrasound examination showed the endometrium in decidual transformation, without identification of embrional or extraembrional structures. The diagnosis was retained miscarriage. During the cervical dilatation, an impressive and uncontrollable haemorrhage occurred. It was decided to perform a total hysterectomy via laparotomy. The macroscopic examination of the uterus showed the cavity empty and the sopravaginal cervical area enlarged, invaded by an ectopic trophoblastic proliferation. The majority of obstetricians will never see a cervical pregnancy; the minority who has to treat this pathology wishes to have never seen one.