Maternal complication of cervical heterotopic pregnancy after successful potassium chloride fetal reduction.
OBJECTIVE
To present a case of maternal morbidity encountered in a cervical heterotopic pregnancy after successful potassium chloride (KCl) injection for transvaginal multifetal pregnancy reduction.


METHODS
Case report.


METHODS
Tertiary referral care center.


METHODS
A woman with heterotopic twin gestation after IVF.


METHODS
Diagnosis of a viable cervical heterotopic pregnancy was made at 6 weeks by ultrasound. A transvaginal reduction by KCl injection of the cervical pregnancy was performed under sonographic guidance.


METHODS
Maternal morbidity and mortality.


RESULTS
Although contents of the gestational sac within the cervix resolved, the trophoblastic tissue increased in both size and vascularity. The patient continued to have self-limited vaginal bleeding throughout the pregnancy. However, at 31 weeks, she had an acute hemorrhage, resulting in an emergency cesarean hysterectomy secondary to profuse bleeding from retained cervical trophoblastic tissue.


CONCLUSIONS
Although KCl transvaginal multifetal pregnancy reduction might successfully terminate a cervical heterotopic pregnancy, the ongoing pregnancy might be complicated by persistence and even enlargement of remaining trophoblastic tissue, leading to obstetric hemorrhage.
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Mount Sinai School of Medicine, New York, New York 10029, USA. cynthia.gyamfi@mssm.edu
Cynthia
C
Gyamfi
Samantha
S
Cohen
Joanne L
JL
Stone
D000328:Adult; D002584:Cervix Uteri / Q000473:pathology; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007044:Hysterectomy; D006473:Postpartum Hemorrhage / Q000473:pathology; D011189:Potassium Chloride / Q000494:pharmacology*; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000009:adverse effects / Q000379:methods*; D011271:Pregnancy, Ectopic / Q000209:etiology* / Q000628:therapy
D011189:Potassium Chloride