Hysteroscopic resection of a cervical ectopic pregnancy. Case report.

Introduction: Cervical ectopic pregnancy (CEP) is a rare form of ectopic pregnancy, accounting for less than 1% of all ectopic pregnancies, with an estimated incidence of 1 in 9,000 pregnancies. Historically, the management of CEP has involved hysterectomy due to the high risk of uncontrolled hemorrhage. However, advancements in early diagnosis through high-resolution ultrasound and serum beta-human chorionic gonadotropin (β-hCG) quantification have allowed for the exploration of conservative management approaches aimed at preserving fertility. Case Presentation: We present the case of a 25-year-old female, with no significant gynecological or obstetric history, who presented to the emergency department with vaginal bleeding. Ultrasound examination revealed a gestational sac located in the endocervical region, without a visible embryo, and β-hCG levels were 4,436 mUI/mL. Medical management with methotrexate was initiated according to a multiple-dose regimen, supplemented with folinic acid, but did not result in adequate resolution. Given the persistent rise in β-hCG levels (8,225 mUI/mL), surgical intervention via hysteroscopy was performed. Under regional anesthesia, hysteroscopic resection of the gestational sac was successfully completed using bipolar energy, achieving effective hemostasis with minimal blood loss (50 mL). The patient had an uneventful recovery and was discharged after 72 hours. Follow-up at three weeks post-procedure showed a decrease in β-hCG to undetectable levels (2.3 mUI/mL). Conclusion: Hysteroscopic resection is a safe and effective conservative treatment option for cervical ectopic pregnancy, minimizing surgical morbidity, preserving fertility, and avoiding radical interventions. However, this approach requires specialized expertise and careful patient selection. Standardized clinical protocols are needed to optimize outcomes and reduce complications.