Doctors save fertility hopes of a patient with cervical pregnancy

New Delhi, August 13, 2015: Doctors from Sri Balaji Action Medical Institute took an unconventional approach for preserving the fertility of a patient reported with a rare form of ectopic pregnancy (occurring outside the uterine cavity) called Cervical Pregnancy. In such cases the foetal sac is formed in Cervix (the lower end of the uterus) and is associated with morbidity and disastrous effects on the future aspects of the patient’s fertility. The doctors shed down the traditional approach which suggests removal of the uterus and successfully treated the patient, keeping her hope of becoming a mother alive. There are only 15 more such cases of Cervical Pregnancy reported across the globe in which uterus has been saved.

28 years old Rashmi (name changed) a 40 days pregnant came to OPD of Sri Balaji Action Medical Institute and reported of painless bleeding clots through vagina since a day. She also had an episode of similar spotting 3-4 days back too. She had no previous history of intrauterine procedures or devices, and no pelvic inflammatory disease. Her Beta-HCG had gone up from 2700 to 5700 and Ultrasound showed normal cardiac activity of the growing baby. On investigations, the team at Sri Balaji Action Medical Institute could see the foetal sac, nodes, cardiac activity all in the cervix.

Speaking about the case Dr. Ruby Sehra, HOD & Sr. Consultant (OBS & Gynae), Sri Balaji Action Medical Institute, sad, “Ectopic pregnancy can occur anywhere away from the uterine cavity including fallopian tube (most common – 98%), ovary, abdomen, etc.  Ectopic pregnancy in the cervix, account for less than 1% of all ectopic pregnancies. Diagnosis of cervical pregnancies also remains a challenge and is often delayed. Methotrexate (MTX) is contraindicated in such cases owing to the risk of uncontrollable bleeding. The massive blood clots often necessitate emergency removal of the uterus.”

Looking at patient profile - young age, married a year back and first pregnancy; Doctors at Sri Balaji Acton Medical Institute decided to avoid the uterus removal and preserve the fertility of the patient. Dr. Ruby Sehra and Dr. Rupinder Singh Baweja, MD (Radiodiagnosis), DM (Neuroradiology), with their team opted for preservative therapeutic approach to safe guard patient’s fertility. Potential risks and alternatives methods were explained to the patient. Evacuation of cervix was performed under GA with the help of Interventional cardiology team performing bilateral uterine artery embolization so as to block the cervical branches.

It was a herculean task to remove the fetus without harming the uterus with minimal blood loss. The post-operative recovery period was uneventful and the patient is in stable condition and we hope that she can carry a normal pregnancy soon, added Dr. Ruby Sehra.

According to Dr. Rupinder Singh Baweja, MD (Radiodiagnosis), DM (Neuroradiology), Sri Balaji Action Medical Institute, “Transcatheter arterial embolization has become a major integral part in the treatment of cervical ectopic pregnancy. Around 16 such cases have been reported successfully so far worldwide and Sri Balaji Action Medical Institute is one of them which effectively helped in preserving the fertility of the patient by avoiding traditional approach of uterus removal. This will surely give a ray of hope to the woman of becoming a mother again”.

Cervical pregnancy is a rare, life-threatening form of ectopic pregnancy occurring in approximately 1:9,000 pregnancies. Cervical pregnancy are high risk cases as they may present with an unexpected life-threatening hemorrhage secondary to the erosion of cervical blood vessels, which may require hysterectomy to save the patient. Given the rarity of the condition, even today, the most effective method of its management is under investigation.