Successful conservative management of a case of cervical ectopic pregnancy complicated with preexisting cardiomyopathy

Abstract

Background: Cervical ectopic pregnancies account for less than 1% of all pregnancies. It may present with abnormal and occasionally heavy bleeding. Aim: To understand the challenges associated with management of cervical ectopic pregnancies and learn to individualize the available treatment modalities for a successful outcome. Case report: A 42-year-old woman, G6P2L2MTP3 with amen-orrhea of 2 months, was diagnosed with cervical ectopic pregnancy of 9 weeks on ultrasonography. She was a known case of dilated cardiomyopathy with type II diastolic dysfunction and an ejection fraction of 25%. The patient was given systemic methotrexate followed by intra-amniotic methotrexate and fetal intracardiac potassium chloride. She was followed up with serial β-human chorionic gonadotropin (hCG) reports. However, she developed abdominal pain with bleeding per vaginum and ultrasonography suggestive of a hematoma. The patient was then taken up for a bilateral uterine artery embolization followed by an immediate suction evacuation. The products of conception sent for histopathology confirmed the microscopic diagnosis of cervical pregnancy. Conclusion: It is a challenging clinical situation to diagnose and manage. It needs to be diagnosed early, and management needs to be individualized. Clinical significance: Even with advanced diagnostic modalities and reduction in current mortality rates, cervical pregnancy remains a life-threatening condition. It is of utmost importance to be thorough with the emerging trends in its management, as it comes with the promise of being unpredictably catastrophic.