title: Heterotopic cervical pregnancy treated with transvaginal ultrasound-guided aspiration resulting in cervical site varices within the myometrium.
abstract: OBJECTIVE
  To report a case of successful treatment of a heterotopic cervical pregnancy from IVF-embryo transfer and intracytoplasmic sperm injection (ICSI) that resulted in uterine varices at the cervical site.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Tertiary university clinical center.
  
  
  METHODS
  A 34-year-old with a history of infertility associated with oligospermia who developed a heterotopic cervical pregnancy diagnosed at 7 weeks gestation.
  
  
  METHODS
  Transvaginal ultrasound (TVS)-guided aspiration of the cervical pregnancy; preoperative placement of bilateral hypogastric artery occlusion balloons; cesarean section.
  
  
  METHODS
  Successful delivery of intrauterine pregnancy; conservation of the uterus.
  
  
  RESULTS
  Successful termination of the cervical site pregnancy was achieved with TVS-guided aspiration. However, the pregnancy was then complicated by development of uterine varices at the cervical site noted on serial obstetric ultrasounds and magnetic resonance imaging (MRI). Successful management of the pregnancy required a multidisciplinary approach and preoperative placement of bilateral hypogastric artery occlusion balloons. A scheduled high fundal classic cesarean section at 37 weeks allowed for safe delivery of a healthy infant. Complete spontaneous resolution of the uterine varices was noted after the delivery.
  
  
  CONCLUSIONS
  It is unclear whether residual ectopic tissue contributed to this later complication; however, it cannot be ignored that the locations of the aborted site and the prominence of dilated venous vasculature in this same location suggests a correlation. The interventions applied are reasonable conservative treatments of a cervical heterotopic pregnancy and a management strategy for uterine varices.
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA. anish.shah@duke.edu
authors.forename: Anish A
authors.initials: AA
authors.lastname: Shah
authors.forename: Chad A
authors.initials: CA
authors.lastname: Grotegut
authors.forename: Creighton E
authors.initials: CE
authors.lastname: Likes
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Miller
authors.forename: David K
authors.initials: DK
authors.lastname: Walmer
mesh_terms: D000032:Abortion, Therapeutic / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D021721:Balloon Occlusion; D002585:Cesarean Section; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005865:Gestational Age; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D050498:Live Birth; D008279:Magnetic Resonance Imaging; D009215:Myometrium / Q000098:blood supply*; D054315:Oocyte Retrieval; D010062:Ovulation Induction; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000601:surgery*; D020554:Sperm Injections, Intracytoplasmic; D013396:Suction; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional; D014648:Varicose Veins / Q000209:etiology* / Q000473:pathology