title: Treatment of heterotopic cervical and intrauterine pregnancy.
abstract: OBJECTIVE
  To find a suitable technique to selectively terminate a cervically implanted embryo while maintaining viability of a concomitant intrauterine pregnancy.
  
  
  METHODS
  A 34-year-old patient achieved a twin pregnancy after 4 IVF attempts. Ultrasound revealed a viable intrauterine and cervical pregnancy. Given our experience with KCl injection for fetal reduction, we offered the patient an attempt to reduce the cervical pregnancy.
  
  
  RESULTS
  Best visualization in this case was obtained by transabdominal scanning. A 6-inch 20-gauge spinal needle was inserted transcervically and maneuvered into the thorax of the embryo. Fetal heart rate ceased even before KCl could be injected. Then 3 cm(3) of saline were injected to provide better visualization of the cervical fetus, and to confirm absence of heart beat. The patient had minor vaginal bleeding for several days. The intrauterine pregnancy progressed uneventfully through 36(1)/(2) weeks with delivery of a healthy, 2, 700-gram newborn.
  
  
  CONCLUSIONS
  Cervical pregnancy is usually considered a life-threatening event. Other factors such as concomitant intrauterine pregnancy and the patient's infertility history generally would be secondary concerns. In this case, we were able to selectively terminate the cervical pregnancy, while preserving the intrauterine one, allowing this couple to have a healthy newborn. Further cases will be necessary to appropriately define risk rates for such an approach.
authors.affiliation: Department of Obstetrics, Wayne State University, Detroit, Mich., USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Carreno
authors.forename: M
authors.initials: M
authors.lastname: King
authors.forename: M P
authors.initials: MP
authors.lastname: Johnson
authors.forename: Y
authors.initials: Y
authors.lastname: Yaron
authors.forename: M P
authors.initials: MP
authors.lastname: Diamond
authors.forename: D
authors.initials: D
authors.lastname: Bush
authors.forename: M I
authors.initials: MI
authors.lastname: Evans
mesh_terms: D000032:Abortion, Therapeutic / Q000009:adverse effects / Q000379:methods; D000328:Adult; D002584:Cervix Uteri; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D011189:Potassium Chloride / Q000008:administration & dosage; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000601:surgery*; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D014592:Uterine Hemorrhage / Q000209:etiology
chemical_list: D011189:Potassium Chloride