[Ectopic pregnancy in the presence of an intrauterine device. Communication of a case and review of the literature]. / Embarazo ectópico en presencia de un dispositivo intrauterino. Comunicación de un caso y revisión de la literatura.

PIP: A rare case of cervical pregnancy in the presence of an IUD is described. A 25-year-old woman with 2 children was treated with injectable hormones for intermittent vaginal bleeding after insertion of an IUD. She was later seen in a health center where removal of the IUD was recommended because of a suspected strangulating endocervical polyp. Uncontrollable hemorrhage during the removal resulted in emergency admittance to the General Hospital of Acapulco and a total hysterectomy and bilateral salpingo-oophorectomy. The postoperative course was uneventful. The case met some of Rubin's criteria for a true cervical pregnancy established in 1911: the uterine cavity was empty, and the site of implantation of the blastocyst was below the internal orifice of the cervix and 1 cm above the external cervical opening. Schneider applied the term cervical pregnancy to all cases in which the pregnancy is "obviously and predominantly" situated in the cervix, whether the placenta extended to the isthmus or the endometrium. No pregnancy of greater than 12 weeks is available for histologic proof because of the growth of the placenta in areas contiguous to the cervix and the effacing effect of the growing ovisac. Numerous etiologic factors for cervical pregnancy have been proposed, of which the 3 finding greatest acceptance have been lack of an adequate endometrium for nidation of the trophoblast, a rapid passage of the egg through the uterine cavity, and a premature closing of the internal opening of the cervix. The frequency of cervical pregnancy has been estimated at 1 in 1000 to 1 in 16,000 pregnancies, but its true frequency is unknown. The case described is of great interest because it occurred with an IUD in place.^ieng