A case of heterotopic pregnancy with intrauterine and cervical pregnancy coexisting: intrasacular KCl injection, intrauterine pregnancy being preserved, and then massive bleeding at 32 weeks

Abstract

A case of heterotopic pregnancy with intrauterine and cervical pregnancy coexisting: intrasacular KCl injection, intrauterine pregnancy being preserved, and then massive bleeding at 32 weeks Javier Navarro Sierra1,*, Andrea Espiau Romera2 , María Jesús Puente Luján1 , Rebeca Herrero Serrano1 , María Jesús Franco Royo1 , Carlos De Bonrostro Torralba1 , Belén Rodríguez Solanilla1 1Department of Obstetrics & Gynecology of Miguel Servet University Hospital, 50009 Zaragoza, Spain 2Department of Obstetrics & Gynecology of Lozano Blesa University Clinical Hospital, 50009 Zaragoza, Spain *Correspondence: jnavarro_11@telefonica.net (Javier Navarro Sierra) Academic Editor: Michael H. Dahan Submitted: 7 February 2021 Revised: 5 May 2021 Accepted: 8 May 2021 Published: 12 January 2022 Abstract Background: Heterotopic pregnancy is the condition in which intrauterine and ectopic pregnancy coexist. The conservative management of the ectopic pregnancy, with the intrauterine pregnancy preserved, has been reported. Case(s): Here, we report a very rare case: intrauterine and cervical pregnancy coexist: intrasacular Potassium chloride (KCL) injection successfully terminated cervical pregnancy with intrauterine pregnancy preserved, but later massive bleeding occurred from the cervix. A 39-year-old woman at 7+1 weeks was diagnosed with a heterotopic cervical gestation, with intrauterine and cervical sac, both with live embryos. The ectopic pregnancy was successfully terminated with intrasacular injection of KCl, preserving the intrauterine pregnancy. At 32+4 weeks of gestation the patient started with a profuse bleeding from the cervical sac, causing maternal hypotension (80/45 mmHg) and tachycardia (160 bpm) and a decelerative pattern in the cardiotocographic fetal monitoring, prompting us to perform caesarean section. The cessation of bleeding was achieved using a double balloon intracervical catheter, which was withdrawn 24 hours after its insertion without observing a new bleeding episode. The patient was discharged after 8 days and the newborn after 35 days of life, both in good health. Conclusions: Conservative treatment of a heterotopic gestation is possible, managing to preserve the viability of the intrauterine pregnancy. Keywords: Cervical heterotopic pregnancy; Conservative management; Heterotopic pregnancy; Pregnancy outcome; Severe bleeding