| Cervico-isthmic corporeal pregnancy with delivery at term: a review of the literature with a case report. | |
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MedLine Citation:
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PMID: 19386140 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: True primary cervical pregnancies are rare. Although these can cause massive hemorrhage, most of these abort during the first trimester without having been diagnosed. However, cervico-isthmic and cervico-isthmic corporeal pregnancies are more likely to persist to an advanced gestation in the second and third trimester and cause profuse bleeding with attempted removal of the placenta. CASE PRESENTATION: A case of cervico-isthmic corporeal pregnancy at term with near exsanguinating hemorrhage is reported. A 35-year-old Sri Lankan woman presented for prenatal care with the complaint of daily, painless vaginal bleeding. An ultrasound showed a cervical pregnancy. Despite counseling regarding the poor outcome of cervical pregnancies, the patient wished to continue the pregnancy. At repeat cesarean section, bleeding was profuse requiring pressure, electrocautery, and oversewing the uterus. The patient developed massive bleeding in the recovery room, requiring laparotomy, and total abdominal hysterectomy to control bleeding. She received multiple blood transfusions and required re-exploration for recurrent hemorrhage. The pathology report revealed a placenta accreta and chorionic villi at the junction of the isthmus and cervix. After a long hospital course, the patient was discharged. CONCLUSION: Cervical pregnancies involving the isthmus and isthmus and corpus are more common than true cervical pregnancies. They are significant because placental involvement of the cervix can cause erosion of the uterine arteries and massive bleeding when placental removal is attempted. Anticipatory planning, including permission for hysterectomy if necessary, may lead to improved maternal and fetal morbidity. TARGET AUDIEnce: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to distinguish the different types of cervical pregnancies, describe management strategies for cervical pregnancies, and summarize the diagnostic criteria for cervical pregnancies. |
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Authors:
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Daniel M Avery; Michael A Wells; Diane M Harper |
Publication Detail:
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Type: Case Reports; Journal Article; Review |
Journal Detail:
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Title: Obstetrical & gynecological survey Volume: 64 ISSN: 1533-9866 ISO Abbreviation: Obstet Gynecol Surv Publication Date: 2009 May |
Date Detail:
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Created Date: 2009-04-23 Completed Date: 2009-06-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0401007 Medline TA: Obstet Gynecol Surv Country: United States |
Other Details:
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Languages: eng Pagination: 335-44 Citation Subset: IM |
Affiliation:
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Department of Obstetrics and Gynecology, University of Alabama, University Medical Center, Tuscaloosa, Alabama 35401, USA. davery@cchs.ua.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Cervix Uteri
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pathology Cesarean Section, Repeat Female Humans Hysterectomy Placenta Accreta / diagnosis Pregnancy Pregnancy Trimester, Third Pregnancy, Ectopic* / diagnosis, etiology, surgery Ultrasonography, Prenatal Uterine Hemorrhage / etiology*, prevention & control |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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