title: Non-viable cervico-isthmic pregnancy: the importance of an accurate sonographic diagnosis to preserve fertility.
abstract: BACKGROUND
  Cervico-isthmic pregnancy is a rare occurrence and until the use of current ultrasonographic techniques was associated with a disastrous outcome for women desiring to maintain their fertility.
  
  
  METHODS
  A 39-year-old woman was diagnosed at 12 weeks of amenorrhoea with an intra-uterine non-viable pregnancy and a low implantation of the gestational sac. Medical management of this situation with a regimen of intravaginal misoprostol was unsuccessful. At introduction of a cervical expander severe vaginal bleeding ensued, leading to an emergency curettage followed by a life-saving hysterectomy. Pathologic examination confirmed the peroperative impression of an isthmic implantation of the gestational sac.
  
  
  CONCLUSIONS
  Early ultrasonographic diagnosis is essential to make conservative management of cervico-isthmic pregnancy possible.
authors.affiliation: Department of Obstetrics and Gynecology, S. João Hospital, Porto, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Loureiro
authors.forename: Manuela
authors.initials: M
authors.lastname: Cunha
authors.forename: Eduarda
authors.initials: E
authors.lastname: Marques
authors.forename: Maria Libânia
authors.initials: ML
authors.lastname: Araújo
authors.forename: Nuno
authors.initials: N
authors.lastname: Montenegro
authors.forename: Ricardo
authors.initials: R
authors.lastname: Laurini
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Exposito
authors.forename: Maria
authors.initials: M
authors.lastname: del Pilar Martinez
mesh_terms: D000328:Adult; D003951:Diagnostic Errors; D005260:Female; D005298:Fertility; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007044:Hysterectomy; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D014463:Ultrasonography