F.E. Augustin, I. Vâlcea, M. Amza, R.M. Sima, L. Pleş, I.M. Conea
Rezumat: Introduction. Cervical pregnancies occur when the fertilized
egg implants in the wall of the cervix below the internal cervical os. The incidence is between 1 in 8600 and 1 in 12,400 pregnancies. The risk factors include previous instrumentation, cervical or uterine surgery, in vitro fertilization with embryo transfer, uterine anomalies, leiomyomas, synechiae, previous caesarean section, and pelvic inflammatory disease. Sonographic findings in cervical
pregnancy may include an hourglass uterine shape, ballooned
cervical canal, gestational tissue at the cervix, absence
of intrauterine gestational tissue, and a portion of the
endocervical canal between the gestation and the endometrial
canal. The medical management includes the systemic
administration of methotrexate, but failure is common in
pregnancies over nine weeks with a crown-rump length
(CRL) greater than 10 mm, presence of embryonic cardiac
activity, and beta-human chorionic gonadotropin (β-HCG)
levels higher than 10,000 mIU/ml. Materials and method.
This paper represents a case report of a 34-year-old woman
with a history of previous caesarean section and elective
abortion, presenting with 8 weeks of amenorrhea. She was
diagnosed one week prior with cervical ectopic pregnancy.
Results. The ultrasound examination revealed the presence of a gestational sac with an embryo showing
cardiac activity, located in the upper part of the cervix,
below the uterine scar. The CRL measured 10 mm, corresponding
to a gestational age of 7 weeks and 1 day. The uterine cavity
displayed an endometrial thickness of 11 mm, and both ovaries appeared normal. With the patient’s informed consent, surgical evacuation was performed, using suction curettage, resulting in minimal bleeding. The cervical lacerations were sutured with transfixion sutures. The
subsequent progress was favorable. Conclusions. While it
is an extremely rare variety of ectopic pregnancy, cervical
pregnancy represents a potential surgical emergency if not
diagnosed in a timely manner. The possible complications
include uterine rupture with subsequent hemorrhage, requiring
hemostatic hysterectomy in such cases. Cuvinte cheie: case report, cervical ectopic pregnancy, curettage, fertility sparing.