Cervical ectopic pregnancy - a review

ABSTRACT

Cervical ectopic pregnancy is the implantation of a pregnancy in the endocervical canal and is a rare entity. Cervical pregnancy is the least common variant of ectopic pregnancy with a reported incidence of < 1% and 1;18000 live births. Diagnosis and management of cervical ectopic pregnancy is a challenging obstetrical entity both for the obstetrician and the radiologist. Diagnostic dilemma still exist because of close resemblance of clinical presentation between cervical ectopic pregnancy and incomplete abortion. Unexpected diagnosis of cervical ectopic pregnancy following dilatation and curettage for a presumed incomplete abortion was not uncommon. Uncontrolled hemorrhage warranted emergency hysterectomy in majority of cases. Advances in sonological techniques have made the diagnosis easy. Dramatic change has been witnessed over the past two decades in this regard. Fertility sparing treatment options are the ray of hope especially for nulliparous women with cervical ectopic pregnancy. Here is a case report of 24 year old nulliparous presented to emergency room with lower abdominal cramping, burning micturition, bleeding per vagina and vomiting of two days' duration. Her last menstrual period was six weeks back. Pelvic examination revealed eight weeks pregnancy with enlarged cervix and bloody mucous discharge from the cervix with unremarkable adnexa. She was found to be positive for pregnancy test. Clinical and biochemical marker [b HCG] suggested ectopic pregnancy with a possibility of cervical ectopic pregnancy following ultrasound examination. As the patient was keen on immediate symptomatic cure she was managed surgically followed by a good postoperative recovery. Misdiagnosis and mismanagement of cervical ectopic pregnancy carry high maternal mortality and morbidity. Literature was reviewed in view of the enigma surrounding the diagnosis and management of cervical ectopic pregnancy. The review revealed the need of appropriate diagnosis and that fertility sparing treatment options [medical methods] are gaining momentum and are found to be effective. High index of clinical suspicion by the obstetrician, aided with high resolution transvaginal scan, should help in making an early appropriate diagnosis. Timely correct diagnosis and intervention with right therapeutic option should prevent high maternal morbidity and mortality associated with cervical ectopic pregnancy