Cervical ectopic pregnancy – the first case of live birth and uterus-conserving management
Abstract A 37-old III gravida II para with two previous cesarean sections (CS) presented in 7 + 3 weeks of pregnancy with cervical ectopic pregnancy (CEP). At 12th week of pregnancy, a cerclage was performed to avoid cervical distention by the expanding placenta. Due to missing experience in CEP man...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-023-05951-5 |
| _version_ | 1827632756408975360 |
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| author | Angela Köninger Buu-Phuc Nguyen Udo Schwenk Mehmet Vural Antonella Iannaccone Jens Theysohn Rainer Kimmig |
| author_facet | Angela Köninger Buu-Phuc Nguyen Udo Schwenk Mehmet Vural Antonella Iannaccone Jens Theysohn Rainer Kimmig |
| author_sort | Angela Köninger |
| collection | DOAJ |
| description | Abstract A 37-old III gravida II para with two previous cesarean sections (CS) presented in 7 + 3 weeks of pregnancy with cervical ectopic pregnancy (CEP). At 12th week of pregnancy, a cerclage was performed to avoid cervical distention by the expanding placenta. Due to missing experience in CEP management and to avoid emergency operation, we recommended CS in 30th week of pregnancy due to unspecific pain of the patient. Vaginal bleeding never occured. After transverse laparotomy, the urinary bladder was sharply dissected from the anterior uterine and cervical wall. The baby was delivered by transverse cervicotomy caudally of the placenta. The placenta was left in situ. The patient then got prophylactic embolization of the uterine arteries to prevent further severe hemorrhage. 48 h later, ultrasound showed a floating, avascular placenta within a poor echogenic fluid-filled cervical space as well as macrohematuria. After re-laparotomy and cervicotomy at the same day, the placenta was completely and easily evacuated. A bladder injury was recognized and closed. We performed a cervical internal os plasty by inverting the cervical lips and suturing their distal ends on the proximal cervical tissue, resulting in complete bleeding cessation. Although, the patient got 8 erythrocyte concentrates at all, she was always in a stable condition without hemorrhagic shock. This case demonstrates for the first time a live-birth with uterus-conserving management in CEP. |
| first_indexed | 2024-03-09T14:50:03Z |
| format | Article |
| id | doaj.art-1fc6382ac62d4667970b6ae5a39a543d |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-03-09T14:50:03Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-1fc6382ac62d4667970b6ae5a39a543d2023-11-26T14:30:55ZengBMCBMC Pregnancy and Childbirth1471-23932023-09-012311710.1186/s12884-023-05951-5Cervical ectopic pregnancy – the first case of live birth and uterus-conserving managementAngela Köninger0Buu-Phuc Nguyen1Udo Schwenk2Mehmet Vural3Antonella Iannaccone4Jens Theysohn5Rainer Kimmig6Department of Gynecology and Obstetrics, University Hospital EssenDepartment of Gynecology and Obstetrics, University Hospital EssenDepartment of Gynecology and Obstetrics, University Hospital EssenDepartment of Gynecology and Obstetrics, University Hospital EssenDepartment of Gynecology and Obstetrics, University Hospital EssenInstitute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital EssenDepartment of Gynecology and Obstetrics, University Hospital EssenAbstract A 37-old III gravida II para with two previous cesarean sections (CS) presented in 7 + 3 weeks of pregnancy with cervical ectopic pregnancy (CEP). At 12th week of pregnancy, a cerclage was performed to avoid cervical distention by the expanding placenta. Due to missing experience in CEP management and to avoid emergency operation, we recommended CS in 30th week of pregnancy due to unspecific pain of the patient. Vaginal bleeding never occured. After transverse laparotomy, the urinary bladder was sharply dissected from the anterior uterine and cervical wall. The baby was delivered by transverse cervicotomy caudally of the placenta. The placenta was left in situ. The patient then got prophylactic embolization of the uterine arteries to prevent further severe hemorrhage. 48 h later, ultrasound showed a floating, avascular placenta within a poor echogenic fluid-filled cervical space as well as macrohematuria. After re-laparotomy and cervicotomy at the same day, the placenta was completely and easily evacuated. A bladder injury was recognized and closed. We performed a cervical internal os plasty by inverting the cervical lips and suturing their distal ends on the proximal cervical tissue, resulting in complete bleeding cessation. Although, the patient got 8 erythrocyte concentrates at all, she was always in a stable condition without hemorrhagic shock. This case demonstrates for the first time a live-birth with uterus-conserving management in CEP.https://doi.org/10.1186/s12884-023-05951-5Cervical ectopic pregnancyLive birthUterus-conservationUterine artery embolizationCervical internal os plasty |
| spellingShingle | Angela Köninger Buu-Phuc Nguyen Udo Schwenk Mehmet Vural Antonella Iannaccone Jens Theysohn Rainer Kimmig Cervical ectopic pregnancy – the first case of live birth and uterus-conserving management BMC Pregnancy and Childbirth Cervical ectopic pregnancy Live birth Uterus-conservation Uterine artery embolization Cervical internal os plasty |
| title | Cervical ectopic pregnancy – the first case of live birth and uterus-conserving management |
| title_full | Cervical ectopic pregnancy – the first case of live birth and uterus-conserving management |
| title_fullStr | Cervical ectopic pregnancy – the first case of live birth and uterus-conserving management |
| title_full_unstemmed | Cervical ectopic pregnancy – the first case of live birth and uterus-conserving management |
| title_short | Cervical ectopic pregnancy – the first case of live birth and uterus-conserving management |
| title_sort | cervical ectopic pregnancy the first case of live birth and uterus conserving management |
| topic | Cervical ectopic pregnancy Live birth Uterus-conservation Uterine artery embolization Cervical internal os plasty |
| url | https://doi.org/10.1186/s12884-023-05951-5 |
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