Successful management of cervico-isthmic pregnancy delivered at term
Article first published online: 29 JUL 2012
© 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology
Journal of Obstetrics and Gynaecology Research
Volume 39, Issue 1, pages 371–374, January 2013
How to Cite
Sakai, A., Fujita, Y., Yumoto, Y., Fukushima, K., Kobayashi, H. and Wake, N. (2013), Successful management of cervico-isthmic pregnancy delivered at term. Journal of Obstetrics and Gynaecology Research, 39: 371–374. doi: 10.1111/j.1447-0756.2012.01967.x
- Issue published online: 7 JAN 2013
- Article first published online: 29 JUL 2012
- Received: January 12 2012.; Accepted: May 10 2012.
- cervico-isthmic pregnancy;
- placental adhesion;
- uterine artery embolization
A 29-year-old woman was diagnosed with a cervico-isthmic pregnancy based on ultrasound findings at 8 weeks of gestation. At 30 weeks of gestation, placenta previa was confirmed. During cesarean section at 37 weeks, the placenta did not spontaneously detach from the uterus; therefore, we decided to leave it in the uterus to avoid major hemorrhage. Blood loss was 775 mL and a healthy infant was delivered. After the operation, weekly methotrexate injection was initiated. Shortly after the eighth course of injection, massive vaginal bleeding suddenly occurred and bilateral uterine artery embolization was performed to control it. After the procedure, the retained placental tissue was removed and the patient was discharged with good general condition. Although a cervico-isthmic pregnancy constitutes a high-risk pregnancy, fertility-sparing management without a hysterectomy or blood transfusion was possible by not removing the placenta manually during the operation.