Edorium Journal of

Gynecology and Obstetrics

 
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Case Report
 
Cervico-isthmic ectopic pregnancy: A case report
Makukhina Tatiana1,2, Knyazeva Natalia2
1Radiology Department Kuban State Medical University, 350000, Sedina, 4, Krasnodar, Russian Federation.
2Municipal Budget Health Care Institution City Clinical Hospital #1, 350000, Krasnaya, 103, Krasnodar, Russian Federation.

Article ID: 100009G06MT2016
doi:10.5348/G06-2016-9-CR-3

Address correspondence to:
Tatiana Borisovna Makukhina
ap.124, Gagarina str
170, Krasnodar
Russian Federation, 350049

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How to cite this article:
Makukhina T., Knyazeva N. Cervico-isthmic ectopic pregnancy: A case report. Edorium J Gynecol Obstet 2016;2:17–20.


Abstract
Introduction: Due to the rarity of cervico-isthmic ectopic pregnancy (CIP) the specialists are insufficiently informed about the diagnosing methods and preferable treatment patterns.
Case Report: We report a case of misdiagnosed CIP manifested by repeated heavy bleeding after curettage. The patient hospitalized at Perinatal Center with complaints of vaginal spotting. Ultrasound scan showed shortened cervix, chorion frondosum presentation just above cervical M-echo and subchorionic hematoma in endometrial cavity above the gestation sac. Attempt of medicamentally induced abortion failed, and dilatation and curettage (D&C) were performed. Massive vaginal bleeding suddenly occurred two weeks later. Trophoblastic invasion into cervix by color Doppler was suspected. Combined management with systemic methotrexate administration and bilateral uterine artery embolization (UAE) was used. Four days after D&C under US control was performed again and no pathology was found two weeks later. The diagnosis could have been formulated on the first admission at the hospital, in spite of low implantation and chorion frondosum presentation. Retrospective analysis of US-video files just before the patient discharge the Perinatal Center shows the high echogenic lesion in the cervico-isthmic area, which was considered a blood clot, but was not confirmed by color Doppler. Only combinations of methods used (UAE, methotrexate administration with subsequent curettage) stopped bleeding.
Conclusion: Early diagnosis of CIP requires US mapping of low implantation. The question of CIP prolongation should be decided individually. CIP termination needs hemorrhage prevention. color Doppler is important as a diagnostic and monitoring tool to exclude chorion persistence after treatment.

Keywords: Cervico-isthmic ectopic pregnancy, Chorion persistence, Color Doppler, Ultrasound diagnosis


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Author Contributions
Makukhina Tatiana – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Knyazeva Natalia – Acquisition of data, Drafting the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Makukhina Tatiana et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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