Second-Trimester Cervico-Isthmic Pregnancy after Donor Egg In Vitro Fertilization, Complicated with Placenta Accreta – Case Report

Emil Kovachev; Simona Anzhel; Zhivko Zhekov; Nikoleta Tabakova; Silviya Dimova

doi:10.3889/oamjms.2022.8705

Authors

Emil Kovachev Department of Obstetrics and Gynecology, Medical University, Varna, Republic of Bulgaria
Simona Anzhel Department of Obstetrics and Gynecology, Medical University, Varna, Republic of Bulgaria https://orcid.org/0000-0002-6142-4451
Zhivko Zhekov Department of Obstetrics and Gynecology, Medical University, Varna, Republic of Bulgaria
Nikoleta Tabakova Department of Obstetrics and Gynecology, Medical University, Varna, Republic of Bulgaria https://orcid.org/0000-0003-4177-3897
Silviya Dimova Department of Social Medicine and Health-care Organization, Medical University, Varna, Republic of Bulgaria

DOI:

https://doi.org/10.3889/oamjms.2022.8705

Keywords:

Cervical pregnancy, In vitro fertilization, Curettage, Methotrexate, Hysterectomy

Abstract

BACKGROUND: Cervical gestations are rare potentially life-threatening conditions. Although these can cause massive hemorrhage, most of them abort during the first trimester without having been diagnosed. However, cervico-isthmic pregnancies are more likely to persist to an advanced gestation in the second and third trimester owing the need for hysterectomy due to defect placentation.

CASE PRESENTATION: We presented a rare case of cervical pregnancy after donor egg in vitro fertilization procedure, with no previous pregnancies, medical, and surgical history. Our patient rejected early termination of pregnancy at 5 gestational weeks. Pregnancy continued until 16 weeks when she was hospitalized and terminated due to medical grounds with curettage. Post-operative period was uneventful until day 20, when she was admitted with suspicion of retained placental tissue and endometritis. A hysterectomy was done with blood transfusion due to excessive blood loss. Histologic examination confirmed placenta accreta spectrum disorder.

CONCLUSION: Cervical pregnancy can be treated conservative if timely diagnosed by early ultrasound, which can reduce the chances of severe life-threatening hemorrhage necessitating hysterectomy or blood transfusion.

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