A combined intrauterine and cervical pregnancy diagnosed in the 13th gestational week: which type of management is more feasible and successful?

OBJECTIVE: To present a case of a simultaneous nonviable cervical pregnancy and viable intrauterine pregnancy diagnosed in the 13th gestational week and to discuss the possible therapeutic options.
DESIGN: Case report.
SETTING: University hospital of Münster, Germany. PATIENT(S): A 40-year-old woman who had undergone IVF-embryo transfer because of previous surgical sterilization. INTERVENTION(S): Hospitalization with observation, expecting spontaneous expulsion of the nonviable cervical pregnancy. MAIN OUTCOME MEASURE(S): Intrauterine pregnancy preservation; maternal morbidity and mortality. RESULT(S): Three weeks after diagnosis, the expulsion of a nonviable cervical pregnancy occurred. It was accompanied by pronounced cervical hemorrhage, conservatively managed with cervical curettage and stitches under general anesthesia. Unfortunately, a few hours later, spontaneous abortion of the intrauterine pregnancy occurred. Blood transfusion was postoperatively avoided, although pronounced anemia was detected (7.3 g/dL). The patient was than discharged 3 days later. CONCLUSION(S): Combined intrauterine and cervical pregnancy is a remote but possible event, particularly after assisted reproductive technology (ART) procedures. Its management should be carefully evaluated, according to the clinical situation and patient's desire. In case of nonviable cervical pregnancy, if a noninterventional approach is chosen, and especially when gestational age is advanced, hospitalization should be recommended in an attempt to prevent possible critical hemorrhagic complications due to cervical pregnancy expulsion.