Successful, safe management of stable viable heterotopic cervical pregnancy (HCP) using transvaginal ultrasound guided needle fetal aspiration and delayed cervical cerclage.
CANSAGE ePoster Library. Michael A. 09/26/19; 275270; eP-137
Amanda Michael
Amanda Michael
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Materials and Methods:We report a case of a viable HCP resulting from clomid ovulation induction. The patient was a 32-year-old G4P1 at 6 weeks and 3 days with ultrasound confirmation of a HCP, with fetal cardiac activity for both fetuses. The patient was counseled regarding the need for intervention to terminate the live cervical pregnancy in an effort to salvage the coexistent viable IUP. In an outpatient setting and under conscious sedation at 7 weeks GA, transvaginal ultrasound- guided, needle fetal aspiration through the vaginal fornix and targeting the gestational sac in the supravaginal cervical canal was performed with no complications. Two days later, the patient presented with intermittent, painless vaginal bleeding and was taken to the OR. Examination revealed a patulous cervix with a blood clot in the cervical canal with slow, but persistent, blood trickling from the external cervical os. The cervical canal was found to be dilated with a blood clot containing products of conception which was easily removed with a ring forceps, completing her cervical abortion. There was minor oozing from the cervix, so a cervical cerclage was performed to ensure complete hemostasis. The patient was discharged home the following morning in stable condition. The IUP continued uneventfully and she is currently 21 weeks gestation at the time of writing this abstract.Conclusion:There is no place for expectant management when presented with stable, early, and viable HCP. Early intervention is essential to prevent future serious hemorrhagic complications and to potentially save the concurrent IUP. Transvaginal ultrasound- guided needle fetal aspiration is a safe approach that achieves fetal reduction without compromising a wanted coexistent IUP. The use of a cervical cerclage was effective to prevent potential continued postoperative bleeding.
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