title: Hysteroscopic management of a heterotopic pregnancy following uterine artery embolization: a case report.
abstract: BACKGROUND
  Intra-uterine pregnancy coexisting with cervical pregnancy (heterotopic pregnancy) is a rare condition and its management is challenging because of the massive bleeding associated with cervical pregnancy. Uterine artery embolization followed by hysteroscopic removal of cervical and intra-uterine products of conception can theoretically prevent massive bleeding and provide a direct view during the removal. Hysteroscopic management following uterine artery embolization of heterotopic pregnancy after in vitro fertilization and embryo transfer is rarely reported.
  
  
  METHODS
  A 33-year-old primigravida, Asian, married, nonsmoker, nonalcoholic woman presented with heavy vaginal bleeding 3 weeks after in vitro fertilization and embryo transfer with a documented history of two embryo implantations in her uterine cavity. Transvaginal ultrasonography revealed a gestational sac of 15 mm × 9 mm × 9 mm with cardiac activity, showing a 3.0-mm-diameter yolk sac in the uterine cavity and a 15 mm × 11 mm × 8 mm gestational sac with cardiac activity, showing a 2.9-mm-diameter yolk sac in the cervical canal. The bilateral uterine artery embolization followed by hysteroscopic removal of both the gestational products was successfully performed after our patient and her family chose to give up the intra-uterine pregnancy due to the risk of heavy bleeding associated with cervical pregnancy.
  
  
  CONCLUSIONS
  Uterine artery embolization followed by hysteroscopic removal of cervical and intra-uterine gestational products in the first trimester is safe and feasible, while preserving future fertility.
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China.
authors.forename: Jigyasa
authors.initials: J
authors.lastname: Subedi
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China.
authors.forename: Min
authors.initials: M
authors.lastname: Xue
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China. dabaoxu@yahoo.com.
authors.forename: Dabao
authors.initials: D
authors.lastname: Xu
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China.
authors.forename: Xinliang
authors.initials: X
authors.lastname: Deng
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China.
authors.forename: Kenan
authors.initials: K
authors.lastname: Yu
authors.affiliation: Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Yang
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000473:pathology*; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D011247:Pregnancy; D063192:Pregnancy, Heterotopic / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy*
keywords: Case report; Cervical pregnancy; Heterotopic pregnancy; Hysteroscopy; Intra-uterine pregnancy; Surgical management; Uterine artery embolization