EP21.33: Imaging diagnosis of cervical ectopic pregnancy: a case report in a university hospital

Cervical ectopic pregnancy is a rare entity with a reported incidence of less than 1% and an etiology that is unknown in 90% of cases, often associated with uterine scarring or previous curettage. The importance of recognising this condition lies in reducing maternal morbidity and mortality secondary to severe hemorrhage. For its ultrasound diagnosis, some findings described by Timor Tritsch in 1994 and Jurkovic in 1996 have been reported, among which are an empty endometrial cavity, a barrel-shaped cervix, presence of a gestational sac below the level of the uterine arteries, absence of the sliding sign, and presence of blood flow around the gestational sac. This case involves a 36-year-old patient who presents with a history of abundant intermittent vaginal bleeding lasting for 14 days. She reported a positive home pregnancy test. Upon admission, vital signs were normal, with generalised mucocutaneous pallor. Gynecological examination revealed scant non-foul smelling vaginal bleeding. BHCG was 2688 mU/L and transvaginal gynecological ultrasound, reported a cervix with the presence of a well-defined image, amorphous echoes, highly vascularised (Doppler 3), located towards the internal cervical os, measuring 44 x 25 x 42mm, and volume of 25cc, compatible with cervical ectopic pregnancy. Cervical length was 47 mm. Given the ultrasound findings, a pelvic MRI was requested, which reported a nodular image with heterogeneous signal intensity, endoluminal location, measuring approximately 44 x 28 x 26 mm, on the internal cervical os, protruding into the endocervical canal. Given the previously reported findings, cervical ectopic pregnancy was confirmed. Cervical ectopic pregnancy is an infrequent diagnosis, specially in primigravid patients. Timely diagnosis through clinical evaluation, imaging, and bHCG levels is crucial for reducing the risk of morbidity and mortality.