Cervical ectopic pregnancy misdiagnosed as an incomplete miscarriage - a steep learning curve
Harjit S Dhaliwal, Jasmina Glogic, Azal El Adwan, Rachna Dwivedi
Cervical pregnancy is a rare form of an ectopic pregnancy that accounts for <1% of all ectopic pregnancies. It results from implantation of the blastocyst in the endocervical canal below the level of the internal os. In the UK the approximate incidence of ectopic pregnancies is 11/1000 with an estimate of around 11,000 ectopic pregnancies diagnosed annually. Although non-tubal ectopic pregnancies account for only 5%of ectopic pregnancies, they contribute to a significant morbidity. Management options for cervical ectopic pregnancies range from conservative drug treatment to radical surgical procedures. Over, the last few decades, the mortality rates of ectopic pregnancies have been reduced. This is due to the early recognition of the condition, improvement in laboratory assay sensitivities, dedicated EPAU (Early pregnancy assessment units), ultrasound technology and finally minimally invasive surgical procedures. We present a case of a 38 year old who was 6 weeks pregnant in her first pregnancy. She initially presented with heavy vaginal bleeding followed by cramping lower abdominal pain. Her initial scan was inconclusive. A follow up scan a week later suggested an incomplete miscarriage. A high clinical index of suspicion was based on the rising serum beta HCG and the findings in theatre.