What is the best treatment of heterotopic cervical pregnancies for a successful pregnancy outcome?
A 36-year-old woman visited our medical center to seek treatment for primary infertility. At her first visit, transvaginal sonography revealed multiple uterine fibroids. Dilatation and curettage was performed due to a missed abortion that was conceived by the first cycle of IVF-ET. In this cycle, a total of seven oocytes were retrieved, five oocytes were fertilized by intracytoplasmic sperm injection, and two embryos were transferred. The initial serum b-hCG level was 191.44 mIU/mL 11 days after embryo transfer, and follow-up levels were 1,540 mIU/mL and 7,970 mIU/mL at 15 days and 18 days after ET, respectively. At 4 weeks and 5 days of gestation, an 8 mm gestational sac with a yolk sac was seen in the intrauterine cavity and a 3 mm gestational sac-like shadow was seen in the cervical canal in the first TVS (). Two days later, she visited the emergency room with vaginal bleeding. The patient was hemodynamically stable at the time of presentation (hemoglobin 11.5 g/dL). At 5 weeks+2 days of gestation, follow-up sonography confirmed a heterotopic cervical pregnancy ().\nAfter explaining the treatment options to the patient, she wanted to try to conserve the IUP. She decided on transvaginal pregnancy reduction of the cervical pregnancy, accepting the risk of severe bleeding and a potential need for emergency hysterectomy.\nSelective reduction of the cervically located gestational sac was planned, with readiness for hysterectomy. Careful intracervical gestational sac reduction without harming the endometrial area was carried out with ovum forceps under abdominal ultrasound guidance. Massive uterine bleeding did not occur. Microscopic findings demonstrated trophoblast and chorionic villi in the evacuated tissue. The postoperative course was uneventful with a postoperative hemoglobin level of 11.3 g/dL. The patient was discharged on the seventh postoperative day in good health, with an intact IUP ().\nWith regular check-ups, the IUP followed without any complications, and an emergency Cesarean section was performed at 40 weeks+5 days of gestation due to failure to progress. An uncomplicated birth of a live newborn weighing 3,360 g occurred; the Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. Written informed consent was obtained from the patient for publication of this case report and the accompanying images, and this report was approved by the Institutional Review Board of CHA Gangnam Medical Center.