O040 CERVICAL PREGNANCY IN A NULLIPAROUS WOMAN: CASE REPORT

Objectives: Cervical pregnancy is a rare life-threatening ectopic pregnancy; its incidence has been estimated 1/1000–1/18000 of all pregnancies. We report our experience on a single case of cervical pregnancy successfully treated conservatively. Materials: A 32 years-old nulliparous woman, 8 weeks pregnant, was referred to our department after an ultrasound examination with an identification of isthmic gestational sac and diagnostic doubt of spontaneous abortion vs cervical localization of pregnancy. Transvaginal ultrasound evaluation by an expert operator showed a cervical gestational sac within an embryo (CRL7mm) and presence of vascular activity. Endometrium appareance was as a decidual reaction. Methods: The woman was admitted to our department, blood exams, urine exam and ECG were performed. Beta hCG serum levels were evaluated every 48h after administration of systemic MTX. At admission therapeutical options were explained to woman, underlyning the high risk for hemorrhage: -sistemic MTX -intraamniotic MTX – uterine arteries embolization if both previous options failed. A single dose systemic MTX protocol was choosen (50mg × m), the Mosteller formula was used for calculating body surface (m) (weight 60 kg; height 164 cm, 1.65m body surface). After 24 hours 50mg MTX were injected into amniotic sac under continous ultrasound visualization, because fetal heart beat was still present. Results: Serum levels oh Beta hCG were monitored every 48 hours, showing a plateau for the first 3 days, followed by a continous decrease after fifth day post MTX. The woman was discharged on day 9 when transvaginal ultrasonography revelead absence of vital emmryo eventhough peritrophoblastic vascularization was still active. Post menstrual evaluation showed no peritrophoblastic vasculrization. Conclusions: Cervical ectopic pregnancy usually was misdiagnosed before performing a curettage with the obvious consequence of hysterectomy for massive hemorrhage. The development of transvaginal scans performed routinely during first trimester pregnancy allows an earl diagnosis with an accuracy of 80%. Sonographic diagnostic criteria have been identified: intracervical gestational sac with a normal shape, internal uterine orifice closed, trophoblastic invasion of uterine cervix through all the depth. An hyseterctomy for acute and massive hemorrhage is a surgical procedure with high morbidity and potential mortality. Earlier diagnosis means a conservative management with much lower morbidity and fertility preserved.