Cervical intramural pregnancy: Report of a rare case
A 22-year-old lady, P1+1, presented at the emergency room, with bleeding P/V. She gave history of having amenorrhea for 12 weeks. A positive pregnancy test report was with her, carried out 1 month back. Routine blood test showed a Hb% of 9 gm%. Ultrasonography (USG) showed [] moderately bulky uterus (98 mm × 76 mm × 65 mm), with empty endometrial canal. Midline endometrial echo was not shifted. Endometrial thickness was normal 7 mm. Internal os was closed. A heterogeneous space occupying lesion (SOL) was found (61 mm × 60 mm) in the cervical region. Sonographic impression was that of a cervical ectopic pregnancy. No adnexal mass was detected and the ovaries were normal. No fluid was present in pouch of Douglas (POD). No pleural fluid/ascites was present. Beta human chorionic gonadotrophin (hCG) level was 28700 mIU/ml at this point of time. Bleeding per vaginal (P/V) was continuous and heavy. General condition of the patient started deteriorating. Our patient presented with active heavy bleeding and from the beginning, owing to the deteriorating condition of the patient termination of the pregnancy was strongly favoured by both physicians and the patient. Emergency laparotomy was carried out and hysterectomy was performed after obtaining the consent.\nThe specimen composed of the uterus with cervix [Figures and ]. No adnexa were present. The uterus measured 9 cm and cervix measured 11.5 cm. Endometrial cavity was empty. Internal os was not open. Cervix showed the presence of adherent haemorrhagic mass, infiltrating into the wall, situated below the anterior peritoneal reflection. On histological examination, no product of conception was seen in sections from the body of the uterus and endometrium showed features of secretory phase. Sections from the haemorrhagic mass in cervical wall showed chorionic villi amidst a lot of haemorrhage [Figures and ], establishing the diagnosis of cervical pregnancy.