Abstract:

Pregnancy that implants in a site outside the uterine cavity is called Ectopic pregnancy. Cervical ectopic pregnancy constitutes only less than 1% of ectopic pregnancies, is potentially life threatening, and treatment on its part is assorting with a great challenge because of possible catastrophic bleeding. The diagnosis of cervical pregnancy can now be made much earlier with the aid of ultrasound and β-human chorionic gonadotropin measurements. Early diagnosis and conservative management with methotrexate can reduce maternal morbidity and mortality.28-year-old gravida 3, para 1, living 1, abortion 1 with a previous caesarean section was seen at 9 weeks and 6 days of amenorrhea with a history of intermittent vaginal bleeding since 4 days and no pain abdomen Ultrasound showed an empty uterine cavity and a gestational sac with cardiac activity located in the cervical canal. Serum beta-human chorionic gonadotropin was significantly elevated to 83,990 mIU/mL. The patient was given methotrexate and leucovorin, supplemented by evacuation and the placement of a Foley catheter for bleeding control. Histopathology confirmed cervical ectopic pregnancy. Serial beta HCG measurements showed a progressive decline, and complete resolution occurred after the institution of multiple doses of methotrexate. Follow-up ultrasound confirmed successful treatment without the risk of surgical intervention (Laparotomy). The most common mode of presentation for cervical ectopic pregnancies is painless vaginal bleeding associated with history of amenorrhea and therefore calls for suspicion of ectopic pregnancy. Early transvaginal ultrasound is mandatory to diagnose ectopic pregnancy. While medical management using methotrexate is very effective, it involves diligent monitoring of beta HCG to guide success and prevent severe complications. The following case illustrates the role of early ultrasound diagnosis and conservative medical management in the treatment of cervical ectopic pregnancy, which may avoid life-threatening haemorrhage and hysterectomy.

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