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Cervical pregnancy

Togas Tulandi, MD, MHCM
Section Editors
Robert L Barbieri, MD
William J Mann, Jr, MD
Deputy Editor
Sandy J Falk, MD, FACOG


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 [5].

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.

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Literature review current through: Nov 2017. | This topic last updated: Sep 13, 2017.
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