A case of cervical pregnancy treated by trans-cervical resection following laparoscopic temporal ligation of uterine arteries

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Cervical pregnancy is an unusually complicated form of pregnancy, accounting for one out of 1000~95000 pregnancies. Women with these pregnancies are often required to have hysterectomies due to severe, uncontrollable hemorrhage. It is necessary to diagnose and treat these types of pregnancies as early as possible, not only to prevent maternal hemorrhage but also to preserve the uterus. A 28-year-old woman was referred for suspected cesarean scar pregnancy at 5 weeks gestation. A flattened gestational sac was seen underneath the uterine anterior wall, located at the previously-incurred cesarean scar. We initially diagnosed this as a cesarean scar pregnancy and treated it with umbilical artery embolization and intra-arterial injection of actinomycin D. However, she had persistent uterine bleeding with the gestational sac descending into the cervical canal. We ultimately diagnosed her with a cervical pregnancy, because the degenerated tissue of the gestational sac was revealed to be attached to the inside of the uterine cervix on hysteroscopic imaging. We successfully performed a trans-cervical resection of the gestational mass after laparoscopic temporal ligation of both uterine arteries.
日本産科婦人科内視鏡学会の論文