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Background <p>Heterotopic cervical pregnancy is an extremely rare condition, defined by the simultaneous presence of an intrauterine&#xa0;gestation and an ectopic gestation located in the uterine cervix. Cervical pregnancies are associated with a high risk of severe hemorrhage owing to the close proximity of the trophoblastic tissue to the uterine blood vessels. Early diagnosis is often challenging, as clinical symptoms are frequently absent or nonspecific. Currently there are no standardized management guidelines for coexisting intrauterine and cervical pregnancies; treatment decisions depend largely on the patient’s desire to continue the intrauterine pregnancy and the clinical expertise of the healthcare team.</p> Case presentation <p>We report the case of a 31-year-old primigravida of Sri Lankan ethnicity with a spontaneous heterotopic pregnancy, who presented at 6 + 5&#xa0;weeks of gestation with vaginal bleeding. Her medical and surgical history were unremarkable. Transvaginal ultrasound revealed a viable intrauterine pregnancy coexisting with a viable cervical ectopic pregnancy. Given the acute bleeding and the patient’s wish to preserve the intrauterine pregnancy, surgical management was chosen. Ultrasound-guided cervical curettage with preemptive bilateral cervical suturing was performed, achieving an effective hemostasis. At 16&#xa0;weeks, a Shirodkar cerclage was placed due to cervical shortening. The pregnancy progressed without complications, and a healthy newborn was delivered via cesarean section at 38 + 6&#xa0;weeks of gestation.</p> Conclusion <p>Given the rarity and potentially life-threatening nature of heterotopic cervical pregnancy, the dissemination of clinical experiences is essential to improve diagnostic accuracy and inform management strategies. This case highlights the importance of early recognition and tailored surgical intervention. Ultrasound-guided evacuation with targeted cervical suturing effectively controlled the hemorrhage while preserving the intrauterine pregnancy, whilst second-trimester cerclage addressed cervical shortening. Our experience supports a conservative and individualized approach guided by patient preferences, clinical stability, and multidisciplinary expertise as a viable strategy for optimizing maternal and fetal outcomes in this rare and high-risk condition.</p>

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Management of heterotopic cervical pregnancy: a case report and review of the literature

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月4日

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  • Giulia Principi,
  • Massimo M. Salvatori,
  • Fernando Ficarola,
  • Giovanni Larciprete

摘要

Background

Heterotopic cervical pregnancy is an extremely rare condition, defined by the simultaneous presence of an intrauterine gestation and an ectopic gestation located in the uterine cervix. Cervical pregnancies are associated with a high risk of severe hemorrhage owing to the close proximity of the trophoblastic tissue to the uterine blood vessels. Early diagnosis is often challenging, as clinical symptoms are frequently absent or nonspecific. Currently there are no standardized management guidelines for coexisting intrauterine and cervical pregnancies; treatment decisions depend largely on the patient’s desire to continue the intrauterine pregnancy and the clinical expertise of the healthcare team.

Case presentation

We report the case of a 31-year-old primigravida of Sri Lankan ethnicity with a spontaneous heterotopic pregnancy, who presented at 6 + 5 weeks of gestation with vaginal bleeding. Her medical and surgical history were unremarkable. Transvaginal ultrasound revealed a viable intrauterine pregnancy coexisting with a viable cervical ectopic pregnancy. Given the acute bleeding and the patient’s wish to preserve the intrauterine pregnancy, surgical management was chosen. Ultrasound-guided cervical curettage with preemptive bilateral cervical suturing was performed, achieving an effective hemostasis. At 16 weeks, a Shirodkar cerclage was placed due to cervical shortening. The pregnancy progressed without complications, and a healthy newborn was delivered via cesarean section at 38 + 6 weeks of gestation.

Conclusion

Given the rarity and potentially life-threatening nature of heterotopic cervical pregnancy, the dissemination of clinical experiences is essential to improve diagnostic accuracy and inform management strategies. This case highlights the importance of early recognition and tailored surgical intervention. Ultrasound-guided evacuation with targeted cervical suturing effectively controlled the hemorrhage while preserving the intrauterine pregnancy, whilst second-trimester cerclage addressed cervical shortening. Our experience supports a conservative and individualized approach guided by patient preferences, clinical stability, and multidisciplinary expertise as a viable strategy for optimizing maternal and fetal outcomes in this rare and high-risk condition.