- Togas Tulandi, MD, MHCM
Togas Tulandi, MD, MHCM
- Professor of Obstetrics and Gynecology
- Milton Leong Chair in Reproductive Medicine
- McGill University, Canada
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- William J Mann, Jr, MD
William J Mann, Jr, MD
- Section Editor — Gynecologic Surgery
- Clinical Professor
- Department of Obstetrics and Gynecology
- Virginia Commonwealth University School of Medicine
Cervical pregnancy is a rare form of ectopic pregnancy in which the pregnancy implants in the lining of the endocervical canal. It accounts for less than 1 percent of ectopic pregnancies [1,2]. The incidence is approximately 1 in 9000 deliveries [3,4]. Cervical pregnancy may be more common in pregnancies achieved through assisted reproductive technologies; it occurs in 0.1 percent of in vitro fertilization pregnancies and accounts for 3.7 percent of IVF ectopic gestations .
The cause is unknown; local pathology related to previous cervical or uterine surgery may play a role given an apparent association with a prior history of curettage or cesarean delivery [3,4]. Another theory is rapid transport of the fertilized ovum into the endocervical canal before it is capable of nidation or because of an unreceptive endometrium.
The most common symptom of cervical pregnancy is vaginal bleeding, which is often profuse and painless [3,4]. Lower abdominal pain or cramps occur in fewer than one-third of patients; pain without bleeding is rare. It is important to think about the possibility of cervical pregnancy in such patients since early diagnosis is critical to avoidance of complications and successful treatment.
The general approach to evaluation of pregnant women with first trimester bleeding is discussed in detail separately. (See "Overview of the etiology and evaluation of vaginal bleeding in pregnant women", section on 'First trimester bleeding'.)
On speculum examination, the external os may be open, revealing fetal membranes or pregnancy tissue, which appear blue or purple. Infrequently, a cystic lesion on the cervical lip is observed and represents trophoblastic invasion into the cervical stroma.
- Yankowitz J, Leake J, Huggins G, et al. Cervical ectopic pregnancy: review of the literature and report of a case treated by single-dose methotrexate therapy. Obstet Gynecol Surv 1990; 45:405.
- Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 2002; 17:3224.
- Ushakov FB, Elchalal U, Aceman PJ, Schenker JG. Cervical pregnancy: past and future. Obstet Gynecol Surv 1997; 52:45.
- Vela G, Tulandi T. Cervical pregnancy: the importance of early diagnosis and treatment. J Minim Invasive Gynecol 2007; 14:481.
- Karande VC, Flood JT, Heard N, et al. Analysis of ectopic pregnancies resulting from in-vitro fertilization and embryo transfer. Hum Reprod 1991; 6:446.
- Jurkovic D, Hacket E, Campbell S. Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively. Ultrasound Obstet Gynecol 1996; 8:373.
- Monteagudo A, Tarricone NJ, Timor-Tritsch IE, Lerner JP. Successful transvaginal ultrasound-guided puncture and injection of a cervical pregnancy in a patient with simultaneous intrauterine pregnancy and a history of a previous cervical pregnancy. Ultrasound Obstet Gynecol 1996; 8:381.
- Hofmann HM, Urdl W, Höfler H, et al. Cervical pregnancy: case reports and current concepts in diagnosis and treatment. Arch Gynecol Obstet 1987; 241:63.
- Kung FT, Lin H, Hsu TY, et al. Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection. Fertil Steril 2004; 81:1642.
- Timor-Tritsch IE, Monteagudo A, Mandeville EO, et al. Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography. Am J Obstet Gynecol 1994; 170:737.
- Jung SE, Byun JY, Lee JM, et al. Characteristic MR findings of cervical pregnancy. J Magn Reson Imaging 2001; 13:918.
- Rubin IC. Cervical pregnancy. Surg Gynecol Obstet 1911; 13:625.
- Wang YL, Su TH, Chen HS. Laparoscopic management of an ectopic pregnancy in a lower segment cesarean section scar: a review and case report. J Minim Invasive Gynecol 2005; 12:73.
- Maymon R, Halperin R, Mendlovic S, et al. Ectopic pregnancies in a Caesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod Update 2004; 10:515.
- Yao, M, Tulandi, T. Practical and current management of tubal and non-tubal ectopic pregnancies. Current Problems in Obstetrics, Gynecology and Fertility 2000; 23:89.
- Hung TH, Jeng CJ, Yang YC, et al. Treatment of cervical pregnancy with methotrexate. Int J Gynaecol Obstet 1996; 53:243.
- Qasim SM, Bohrer MK, Kemmann E. Recurrent cervical pregnancy after assisted reproduction by intrafallopian transfer. Obstet Gynecol 1996; 87:831.
- Dotters DJ, Katz VL, Kuller JA, McCoy MC. Successful treatment of a cervical pregnancy with a single low dose methotrexate regimen. Eur J Obstet Gynecol Reprod Biol 1995; 60:187.
- Sieck UV, Hollanders JM, Jaroudi KA, Al-Took S. Cervical pregnancy following ultrasound-guided embryo transfer. Methotrexate treatment in spite of high beta-HCG levels. Hum Reprod 1997; 12:1114.
- Mesogitis S, Pilalis A, Daskalakis G, et al. Management of early viable cervical pregnancy. BJOG 2005; 112:409.
- Kirk E, Condous G, Haider Z, et al. The conservative management of cervical ectopic pregnancies. Ultrasound Obstet Gynecol 2006; 27:430.
- Jeng CJ, Ko ML, Shen J. Transvaginal ultrasound-guided treatment of cervical pregnancy. Obstet Gynecol 2007; 109:1076.
- Hung TH, Shau WY, Hsieh TT, et al. Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review. Hum Reprod 1998; 13:2636.
- Weibel HS, Alserri A, Reinhold C, Tulandi T. Multidose methotrexate treatment of cervical pregnancy. J Obstet Gynaecol Can 2012; 34:359.
- Mitra AG, Harris-Owens M. Conservative medical management of advanced cervical ectopic pregnancies. Obstet Gynecol Surv 2000; 55:385.
- Monteagudo A, Minior VK, Stephenson C, et al. Non-surgical management of live ectopic pregnancy with ultrasound-guided local injection: a case series. Ultrasound Obstet Gynecol 2005; 25:282.
- Doubilet PM, Benson CB, Frates MC, Ginsburg E. Sonographically guided minimally invasive treatment of unusual ectopic pregnancies. J Ultrasound Med 2004; 23:359.
- Fylstra DL. Cervical pregnancy: 13 cases treated with suction curettage and balloon tamponade. Am J Obstet Gynecol 2014; 210:581.e1.
- Ash S, Farrell SA. Hysteroscopic resection of a cervical ectopic pregnancy. Fertil Steril 1996; 66:842.
- Yao, M, Tulandi, T. Practical and current management of tubal and non-tubal ectopic pregnancies. Curr Prob Obstet Gynecol Fertil 2000; 23:89.
- Frates MC, Benson CB, Doubilet PM, et al. Cervical ectopic pregnancy: results of conservative treatment. Radiology 1994; 191:773.
- Zakaria MA, Abdallah ME, Shavell VI, et al. Conservative management of cervical ectopic pregnancy: utility of uterine artery embolization. Fertil Steril 2011; 95:872.
- Hansch E, Chitkara U, McAlpine J, et al. Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience. Am J Obstet Gynecol 1999; 180:1454.