Cervico-isthmic pregnancy ending with the delivery of a live-born infant in late second trimester
Department of Obstetrics and Gynecology A, and the Department of Pathology, Meir Hospital, Kfar-Saba, Sackler Medical School, Tel-Aviv University, IsraelEuropean Journal of Obstetrics & Gynecology and Reproductive Biology (Impact Factor: 1.7). 08/1985; 20(1):61-4. DOI: 10.1016/0028-2243(85)90084-X
A very rare case of cervico-isthmic pregnancy, terminated by cesarean section in late second trimester with the delivery of a live-born infant who subsequently remained alive, is described. The authors suggest that this is the first case of neonatal survival in late second trimester of a cervico-isthmic pregnancy.
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ABSTRACT: Cervicoisthmic pregnancy has a high risk of abortion or preterm delivery, and only 11 cases of live birth have been reported since 1980. In addition, almost all cases require blood transfusion and hysterectomy because of profuse bleeding after delivery of the placenta. A 39-year-old nulliparous woman who became pregnant after a fourth intracytoplasmic sperm injection was diagnosed with cervicoisthmic pregnancy on ultrasonography at 6 weeks' gestation. A healthy neonate was delivered by cesarean section at 32 weeks, but hysterectomy and blood transfusion were required. Perinatal management is discussed.
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ABSTRACT: True primary cervical pregnancies are rare. Although these can cause massive hemorrhage, most of these abort during the first trimester without having been diagnosed. However, cervico-isthmic and cervico-isthmic corporeal pregnancies are more likely to persist to an advanced gestation in the second and third trimester and cause profuse bleeding with attempted removal of the placenta. A case of cervico-isthmic corporeal pregnancy at term with near exsanguinating hemorrhage is reported. A 35-year-old Sri Lankan woman presented for prenatal care with the complaint of daily, painless vaginal bleeding. An ultrasound showed a cervical pregnancy. Despite counseling regarding the poor outcome of cervical pregnancies, the patient wished to continue the pregnancy. At repeat cesarean section, bleeding was profuse requiring pressure, electrocautery, and oversewing the uterus. The patient developed massive bleeding in the recovery room, requiring laparotomy, and total abdominal hysterectomy to control bleeding. She received multiple blood transfusions and required re-exploration for recurrent hemorrhage. The pathology report revealed a placenta accreta and chorionic villi at the junction of the isthmus and cervix. After a long hospital course, the patient was discharged. Cervical pregnancies involving the isthmus and isthmus and corpus are more common than true cervical pregnancies. They are significant because placental involvement of the cervix can cause erosion of the uterine arteries and massive bleeding when placental removal is attempted. Anticipatory planning, including permission for hysterectomy if necessary, may lead to improved maternal and fetal morbidity. TARGET AUDIEnce: Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader should be able to distinguish the different types of cervical pregnancies, describe management strategies for cervical pregnancies, and summarize the diagnostic criteria for cervical pregnancies.
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