Treatment of heterotopic cervical pregnancies

Objective: To describe a rare case of a heterotopic pregnancy with a gestational sac in the cervix and one in the uterine cavity, managed successfully with subsequent delivery of a healthy newborn. Design: Case report and review of the literature. Setting: Tertiary university hospital. Patient(s): A woman with heterotopic twin gestation after stimulation treatment at 9 weeks gestation. Transvaginal ultrasound scan revealed two gestational sacs containing two viable fetuses: one sac inside the uterine cavity and the other sac in the uterine cervix. Intervention(s): Selective termination of the cervical pregnancy by curettage under sonographic guidance in combination with cervical cerclage. Main Outcome Measure(s): Intrauterine pregnancy preservation; maternal morbidity and mortality. Result(s): The termination of the cervical pregnancy was performed successfully without intraprocedural or post-procedural complications with preservation of the patient's fertility. The intrauterine pregnancy progressed uneventfully through 39 1/2 weeks with delivery of a healthy newborn. Conclusion(s): Combined intrauterine and cervical pregnancy is a remote but possible event, particularly after assisted reproductive technology procedures with a high rate of maternal morbidity. Other factors such as concomitant intrauterine pregnancy and the patient's infertility history generally would be secondary concerns. In this case, we were able to terminate the cervical pregnancy selectively, while preserving the intrauterine one, allowing this couple to have a healthy newborn. (Fertil Steril (R) 2011; 95: 1787. e9-e13. (C) 2011 by American Society for Reproductive Medicine.)