Inevitable miscarriage mimicking a live cervical ectopic
Bleeding per vagina, elevated beta hCG. No previous ultrasound.
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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.
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 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. Furthermore the presence of cardiac activity in an endocervical miscarriage is an unusual feature. Therefore, despite the final diagnosis of an inevitable miscarriage in this case, this appearance should be managed as a cervical ectopic until proven otherwise.