Successful pregnancy outcome in a case of heterotopic intrauterine and cervical pregnancy and a literature review.
It is difficult to treat cervical pregnancy without harming the intrauterine pregnancy. We report the case of a patient who was 37 years old and had an abdominal myomectomy. She had become pregnant by in vitro fertilization and egg transfer, and was transferred because of massive bleeding at 6 weeks of gestation. Afterwards, Escherichia coli infection was detected and intravenous antibiotics were administered. Careful intracervical mass reduction and curettage were performed under abdominal ultrasound guidance. The postoperative course was uneventful and she gave birth by cesarean section at 38 weeks. Sixteen cases exist in the literature. Treatment of cervical pregnancy was performed by KCl injection in six cases, hyperosmotic glucose injection in one and complete cervical evacuation in nine. The nine patients that had cervical evacuation delivered at term. In seven cervical mass preservation cases, one patient with twin pregnancy delivered at 34 weeks, and six with singletons delivered at 31-36 weeks. The best therapy is complete evacuation in early gestation in order to avoid infection, bleeding and premature birth. The authors emphasize abdominal ultrasound usage through the bladder window with 150-200 mL of water (or urine) for careful cervical mass reduction and curettage without harming the intrauterine pregnancy.
Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan. hoshino-tm-653255@nifty.com
Tatsuji
T
Hoshino
Masato
M
Kita
Yukihiro
Y
Imai
Shoji
S
Kokeguchi
Masahide
M
Shiotani
D000328:Adult; D002584:Cervix Uteri / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000382:microbiology / Q000601:surgery*