1. A Case of Cervical
Pregnancy
Frank O’Keeffe
AGTS Meeting, Tasmania 2011

2. Cervical Pregnancy
 27 year old
 Para 1 Delivered by Emerg Caesarian Section at term
Obstructed labour 2008
 1 miscarriage at 9 weeks…D&C 2009
 Fit and well
 Trying for pregnancy
 Positive preg test, unsure dates ….Dating scan

3. Dating scan

4. Cervical ectopic pregnancy

5. Cervical Ectopic Pregnancy
 Rare, < 1% of all ectopics
 ?more common ART IVF ?3%
 Assoc with prev surgery/ curettes
 SIGN Hour glass uterus, GS below UA
 Discrete sac doesn’t move ? FH
 Dx U/Soundimpression 88% correct

6. Differential Dx
 Caesar scar Ectopic
 Above UA
 Anterior wall
 Incomplete Miscarriage
Moves, Less discrete sac
Other products /Clot in uterus
Ext os open
?MRI

7.  Manage conservatively with MTX
 Wants more children
 ? Avoid disaster
 Local experience and tertiary advice indicate high
chance of morbidity & possible hysterectomy
 Pt aware of risks and consents to Rx

8. What to Do???
 Manage as tubal ectopic / no literature for Cx preg
 Surgical
 Past Caesar ? Wound ectopic
 ? Incomplete M/carriage
 ? Risk profile
 Local experience
 Tertiary Opinion

9. Follow up
 Need compliant patient
 Serial bhCG
 Pt to present if significant bleeding /Cramping pain

10. MTX Protocols
Single Dose Multidose
 hCG 50mg/m2  1mg /kg IM bhCG +folinic
acid 0.1mg/kg oral
 Day 4 hCG
 Day 7 hCG
 Day 3,5,7 bhCG if < 15%
drop rpt dose
 If <15% drop Repeat dose  Up to 5 doses

11. Cervical ectopic
 BUT bhCG rises and continues to rise
 Fetal heart activity
 Enlarging sac Min Loss
 Cx expanding……………….WHAT TO DO!!!!!

12. Ultrasound

13. CD serial scan

14. Cervical Pregnancy
 Gyn Onc Consult
 GOG Protocol Trophoblastic Disease
 MTX 50mg /m2 weekly / folinic acid
 Twice weekly bhCG

15. Cervical pregnancy
 Pt not happy wants curette
 Bh CG begins to fall
 Fetal heart stops
 Gradual resolution over 10 weeks
 bhCG 0 at 16 weeks post Dx
 Sac resorption

16. Serial Scan

17. Serial Scan

18. Cervical Pregnancy
 Wants more children How to counsel
 ? Risks Possible complications of cx pregnancy
 C/Section
 Curette
 Cx ectopic
 ? Cx incompetence
 ? Recurrence

19. Pregnant Again 6Mo Later
 Early Scan (s)
 Cervical length
 Cx 46mm at 20w
 Normal pregnancy
 Planned Rpt Elective C/Section 38-39 weeks

20. Result
 Delivers baby boy
 5720 g !!!!!!
 Uncomplicated post op
 Planning another!!!!!!!

21. Thank You
Enjoy North West Tassie