Retention of an Intrauterine Pregnancy After the Removal of a Heterotopic Cervical Twin Pregnancy

Cervical pregnancy is an uncommon form of ectopic pregnancy, and when combined with a coexisting intrauterine gestation, it represents a particularly rare and challenging clinical scenario. We report the case of a 46-year-old woman with a history of multiple IVF attempts who conceived after the transfer of two blastocysts. At eight weeks, ultrasound revealed a heterotopic triplet pregnancy: a monochorionic twin cervical ectopic pregnancy alongside a singleton intrauterine gestation. Cardiac activity was present in all fetuses. After counseling, selective evacuation of the cervical pregnancy was performed via dilatation and curettage, followed by prophylactic cervical cerclage to prevent iatrogenic insufficiency. The intrauterine pregnancy progressed uneventfully until 32 weeks, when placental insufficiency developed. Delivery by cesarean section at 34 weeks resulted in a healthy male neonate weighing 2100 g, discharged after a brief NICU stay. This report highlights an exceptionally rare case of heterotopic cervical twin pregnancy coexisting with a viable intrauterine pregnancy. It emphasizes the importance of early diagnosis, individualized management, and multidisciplinary care to optimize both maternal safety and fetal outcome.