Cervical ectopic pregnancy

Cervical ectopic pregnancy is a rare subtype of ectopic pregnancy.

It accounts for ~0.15-1% of all ectopic pregnancies.

Implantation of the fertilized ovum occurs within the cervix rather than the uterine cavity. Unless the fetal heart rate can be identified, it is difficult to distinguish from a miscarriage with fetal parts in the cervical os.

Risk factors
Ultrasound

Can be seen as a gestational sac within the cervix which gives an hour-glass appearance to the uterus. Usually, internal os is closed. At times the gestational sac extends into the lower uterine segment (abnormally low sac position). There is hyperechoic decidual reaction around the gestational sac.

Colour Doppler imaging can be helpful in showing a hypervascular trophoblastic ring in the cervical region in cases of live cervical ectopic pregnancies.

The goal is to treat the condition whilst minimising the risk of severe haemorrhage, and to preserve the patient's future reproductive potential.

Medical management options include methotrexate (a folate antagonist) either administered systemically or by direct injection, or potassium chloride (direct injection).

Surgical curettage runs the risk of life threatening haemorrhage. A preoperative uterine embolisation is an option for reduction of haemorrhage risk 4,6,7.

Complications

Severe haemorrhage is the main complication of surgical management. It may result in the need for hysterectomy, and is potentially life threatening.

  • it is important to consider miscarriage in progress as a differential when the gestational sac is located within the endocervical canal; features suggestive of a miscarriage include:
    • absent embryonic cardiac activity
    • open internal os: lack of typical hour glass appearance
    • sac shape and location often changes on serial scans and it may be possible to alter the location of the sac with gentle probe maneuvering ("sliding sac sign")
    • subsequent loss of the fetal sac on a repeat ultrasound confirms miscarriage
Ultrasound - obstetric
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Article information

rID: 1092
System: Obstetrics
Synonyms or Alternate Spellings:
  • Cervical ectopic
  • Cervical ectopic pregnancies
  • Cervical ectopics

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Cases and figures

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    Figure 1: location of ectopics
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    Case 1
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