IMR Press / CEOG / Volume 49 / Issue 1 / DOI: 10.31083/j.ceog4901012
Open Access Case Report
A case of heterotopic pregnancy with intrauterine and cervical pregnancy coexisting: intrasacular KCl injection, intrauterine pregnancy being preserved, and then massive bleeding at 32 weeks
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1 Department of Obstetrics & Gynecology of Miguel Servet University Hospital, 50009 Zaragoza, Spain
2 Department of Obstetrics & Gynecology of Lozano Blesa University Clinical Hospital, 50009 Zaragoza, Spain

Academic Editor: Michael H. Dahan

Clin. Exp. Obstet. Gynecol. 2022 , 49(1), 12; https://doi.org/10.31083/j.ceog4901012
Submitted: 7 February 2021 | Revised: 5 May 2021 | Accepted: 8 May 2021 | Published: 12 January 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: Heterotopic pregnancy is the condition in which intrauterine and ectopic pregnancy coexist. The conservative management of the ectopic pregnancy, with the intrauterine pregnancy preserved, has been reported. Case(s): Here, we report a very rare case: intrauterine and cervical pregnancy coexist: intrasacular Potassium chloride (KCL) injection successfully terminated cervical pregnancy with intrauterine pregnancy preserved, but later massive bleeding occurred from the cervix. A 39-year-old woman at 7+1 weeks was diagnosed with a heterotopic cervical gestation, with intrauterine and cervical sac, both with live embryos. The ectopic pregnancy was successfully terminated with intrasacular injection of KCl, preserving the intrauterine pregnancy. At 32+4 weeks of gestation the patient started with a profuse bleeding from the cervical sac, causing maternal hypotension (80/45 mmHg) and tachycardia (160 bpm) and a decelerative pattern in the cardiotocographic fetal monitoring, prompting us to perform caesarean section. The cessation of bleeding was achieved using a double balloon intracervical catheter, which was withdrawn 24 hours after its insertion without observing a new bleeding episode. The patient was discharged after 8 days and the newborn after 35 days of life, both in good health. Conclusions: Conservative treatment of a heterotopic gestation is possible, managing to preserve the viability of the intrauterine pregnancy.

Keywords
Cervical heterotopic pregnancy
Conservative management
Heterotopic pregnancy
Pregnancy outcome
Severe bleeding
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