Prabha Sinha, Nidal Jabbur, Mohamed Otify
Am J Case Rep 2009; 10:44-46
Background: Cervical ectopic pregnancy is a rare occurrence. Incidence ranges from 1:1000 to 18,000 pregnancies (<1% of all ectopic pregnancies). Diagnosis is usually made on the clinical symptoms and transvaginal ultrasound scan findings. The most common clinical finding is severe bleeding through vaginal canal. Cervical/Isthmic pregnancy has a poor if left untreated, with 15% to 40% of women requiring hysterectomy. A variety of treatment modalities have been reported in the management of cervical ectopic pregnancy. A new treatment modality with laparoscopic assisted uterine artery ligation followed by hysteroscopic local endocervical resection in cases where bleeding is persistent .
Case Report: This case presents an unusual ectopic pregnancy that was difficult to diagnose initially and diagnosis of lower segment (isthmic) ectopic rupturing inside the abdominal cavity was made during laparotomy. She was given a single dose of intramuscular Methotrexate in view of remnant chorionic tissue (as it was impossible to remove all tissues from the whole avoiding damage to ureter and pelvic vessels)
Conclusions: This case is extremely unusual in its site and presentation. Treatment with a combination of surgical removal and chemotherapy has a good outcome including emergent attainment of hemostasis by local tamponade.
Keywords: Isthmic ectopic, cervical ectopic, ectopic pregnancy, laparoscopy for ectopic, methotrexate for ectopic