Cervical Pregnancy – An experience in a tertiary care centre

Abstract

Background: Cervical pregnancy is a rare form of ectopic pregnancy associated with increased risk of severe haemorrhage. Traditionally, cervical pregnancies were managed by hysterectomy, but with the use of early transvaginal ultrasound, conservative approaches have been successful. However, literature evidence is scarce with no management guidelines. Objectives: The objective was to estimate the incidence of cervical pregnancy, and to determine its risk factors, presenting symptoms, and management. Methods: This was a retrospective descriptive study conducted among women diagnosed with cervical ectopic pregnancy at a tertiary care centre in south India. Results: The study included a total of eighteen cases. The incidence of cervical pregnancy was 1 in 328. Bleeding per vaginum was the most common presenting symptom. Majority (94.4%) of the cases conceived on infertility treatment – three by ovulation induction, three by intrauterine insemination and eleven by artificial reproductive technique. As a part of infertility evaluation, fourteen cases had hysterolaparoscopy and four had undergone D&E. Systemic methotrexate 1mg/kg intramuscularly was given to 88.9% cases (81.3% cases responded to single dose and 18.7% cases required multiple doses) followed by suction evacuation (S&E) 48 hours later. Cardiac activity persisted (after multiple doses of methotrexate) in two cases and intrasac instillation of potassium chloride was done. Ligation of descending cervical artery (DCA) was done in all cases. Conclusion: Cervical pregnancies should be looked for in early pregnancy scans of individuals who have undergone infertility treatments or having a history of uterine surgery. It may be advisable to consider ligating the DCA before performing an evacuation procedure to help minimize the risk of excessive bleeding associated with the surgery.