title: Management of a cervical heterotopic pregnancy presenting with first-trimester bleeding: case report and review of the literature.
abstract: OBJECTIVE
  To report a rare case of a cervical heterotopic pregnancy resulting from intrauterine insemination (IUI) that presented with first-trimester bleeding.
  
  
  METHODS
  Case report and literature review.
  
  
  METHODS
  Large university-affiliated infertility practice.
  
  
  METHODS
  A 40-year-old gravida 2 para 1 Asian woman at 7-3/7 weeks gestational age following clomiphene citrate/IUI for the treatment of secondary infertility presented with heavy vaginal bleeding for several days.
  
  
  METHODS
  Transvaginal ultrasound on admission revealed a single live intrauterine pregnancy and a cervical gestational sac containing a nonviable embryo. The patient continued to have vaginal bleeding and 2 days later underwent removal of the cervical ectopic pregnancy tissue with ring forceps, as well as an ultrasound-guided intracervical Foley balloon and cerclage placement. The bleeding subsided, and 48 hours later the Foley and cerclage were removed.
  
  
  METHODS
  Pregnancy outcome.
  
  
  RESULTS
  The remainder of the pregnancy was uncomplicated and the patient had a full-term cesarean delivery for footling breech of a healthy male infant.
  
  
  CONCLUSIONS
  Cervical heterotopic pregnancy is a very rare event that almost universally results from infertility treatment. We present a case where we were able to remove the cervical ectopic and tamponade the bleeding, thus preserving the intrauterine pregnancy for this subfertile couple, and we review the existing literature.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA. vmoragia@bidmc.harvard.edu
authors.forename: Vasiliki A
authors.initials: VA
authors.lastname: Moragianni
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Hamar
authors.forename: Colin
authors.initials: C
authors.lastname: McArdle
authors.forename: David A
authors.initials: DA
authors.lastname: Ryley
mesh_terms: D000328:Adult; D002584:Cervix Uteri; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000628:therapy*; D059285:Pregnancy, Twin / Q000502:physiology; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy*