MRI showed a low lying gestation sac with empty endometrial cavity above it. The cervix was shortened with a closed cervical canal and internal os. There was a large low lying placenta surrounding the sac with loss of interface between the placenta and myometrium. The myometrium was thinned out. A diagnosis of cervico-isthmic pregnancy was made with the likelihood of adherent placenta.
CERVICO-ISTHMIC PREGNANCY
INTRODUCTION: A cervico-isthmic pregnancy is an ectopic pregnancy which implants in the isthmus. The isthmus is the region between the cervix and fundus.
It is a rare complication of pregnancy and is often confused with a cervical pregnancy. Distinguishing between these is crucial as a cervical pregnancy is virtually not viable while there are a few reports of cervico-isthmic pregnancies being carried successfully to term. Also, cervical pregnancies are more dangerous and associated with serious risks like haemorrhage, rupture, blood transfusions, hysterectomy etc.
INCIDENCE:
Incidence of cervical pregnancy: 1:1000 to 1:16000.
Cervico-isthmic pregnancies are more common than true cervical pregnancies.
IMAGING FINDINGS:
USG: Typically, ultrasound shows an empty uterine cavity with a low lying pregnancy. It may be confused with true cervical pregnancy. In a true cervical pregnancy, the sac is completely within the cervix.
MRI: shows a low lying gestation sac with a well preserved and closed cervical canal. It is hence helpful in distinguishing cervical from cervico-isthmic pregnancy.
IMPLICATIONS: Although there are reports of successful cervico-isthmic pregnancies, these pregnacies are also exposed to risks like:
- Spontaneous abortion/ premature delivery
- premature rupture of membranes
- placenta accreta
- postpartum hemorrhage
- hysterectomy
- Uterine rupture if associated with thinned out myometrium
- Oyelese Y, Elliott T B, Asomani N, Hamm R, Napoli L, Lewis KM: Sonography and Magnetic Resonance Imaging in the Diagnosis of Cervico-Isthmic pregnancy. J Ultrasound Med 2003; 22: 981-983
- Strobelt N, Locatelli A, Ratti M, Ghidini A: Cervico-isthmic pregnancy: a case report, critical appraisal of the diagnostic criteria, and reassessment of the outcome. Acta Obstet Gynecol Scand 2001; 80: 586-588.
- Jelsema RD, Zuidema L: First trimester diagnosed cervico-isthmic pregnancy resulting in term delivery. Obstet Gynecol 1992; 80: 517-519
- Wikipedia
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