Inevitable miscarriage mimicking a live cervical ectopic

Case contributed by Dr Alexandra Stanislavsky

Presentation

Bleeding per vagina, elevated beta hCG. No previous ultrasound.

Patient Data

Age: 30 years
Gender: Female

The endometrial cavity is empty.  There is however a gestational sac located within the cervix, which contains a yolk sac and a fetal pole with cardiac activity. No perigestational haemorrhage is seen.

Case Discussion

The finding of a gestational sac within the endocervix has two differentials:  a cervical ectopic, and an inevitable miscarriage.  

On follow-up in this case, products of conception were passed soon after this ultrasound, and a subsequent scan showed an empty uterus and endocervix, confirming the diagnosis of inevitable miscarriage.

Nonetheless, this appearance should have a high index of suspicion for a cervical ectopic, which is a potentially more serious diagnosis, with risk of haemorrhage.

Notably the presence of cardiac activity in an endocervical miscarriage is an unusual feature in this case. 

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Case information

rID: 29009
Case created: 26th Apr 2014
Last edited: 1st Dec 2015
System: Obstetrics
Inclusion in quiz mode: Included

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