Cervical ectopic pregnancy

A cervicalCervical ectopic pregnancy is a rare subtype of ectopic pregnancy.

Epidemiology 

It accounts for ~ 0~0.15 - 1 -1% of all ectopic pregnancies.

Pathology

Implantation of the fertilized ovum occurs within the cervix rather than the uterine cavity. Unless the fetal heart rate can be identified, it is difficult to distinguish from a miscarriage with fetal parts in the cervical os.

Radiographic assessment

Ultrasound

Can be seen as a gestational sac within the cervix. At times the gestational sac extends into the lower uterine segment (abnormally low sac position).

Colour Doppler imaging can be helpful in showing a hypervascular trophoblastic ring in the cervical region in cases of live cervical ectopic pregnancies.

Management

The goal is to treat the condition whilst minimising the risk of severe haemorrhage, and to preserve the patient's future reproductive potential.

Medical management options include methotrexate (a folate antagonist) either administered systemically or by direct injection, or potassium chloride (direct injection).

Surgical curettage runs the risk of life threatening haemorrhage.  Preoperative uterine embolisation is an option for reduction of haemorrhage risk^4,6,7.

Complications

Severe haemorrhage is the main complication of surgical management. It may result in the need for hysterectomy, and is potentially life threatening.

Differential diagnosis

• It is important to consider miscarriage in progress as a differential when the gestational sac is located within the endocervical canal. Features suggestive of a miscarriage include:
  • cardiac activity of a fetal pole in the endocervical canal will generally be absent.
  • in cases of spontaneous abortion, the sac shape and location often changes on serial scans and it may be possible to alter the location of the sac with gentle probe maneuouvering.
  • subsequent loss of the fetal sac on a repeat ultrasound confirms miscarriage.

See also

• ectopic pregnancy