Cervical Pregnancy
Cervical Pregnancy
A cervical pregnancy is a rare form of ectopic pregnancy in which the gestational sac implants within the endocervical canal below the level of the internal os, rather than in the uterine cavity or fallopian tube. This abnormal implantation is considered intrauterine-ectopic, carries a significant risk of severe hemorrhage due to the cervix’s limited contractility and rich vascularity, and often presents with painless vaginal bleeding in early pregnancy.
Risk: High risk of significant bleeding, particularly with placental manipulation or removal, due to cervical anatomy and vascularity.
Diagnosis
Ultrasound criteria commonly include an empty uterine cavity, a barrel-shaped cervix, a gestational sac located below the internal os, absence of the “sliding sign,” and peritrophoblastic blood flow on color Doppler.
It must be differentiated from an ongoing miscarriage where products of conception are transiently within the cervix; in miscarriage, the sac tends to slide with probe pressure and appears collapsed, unlike a fixed, round/oval sac in cervical pregnancy.
MRI may assist when ultrasound findings are equivocal, especially to distinguish from cesarean scar pregnancy located above the internal os.
Many cervical pregnancies abort in the first trimester; however, more proximal cervico-isthmic variants can persist longer and carry increased hemorrhage risk.
Management ranges from conservative approaches (e.g., methotrexate, tamponade, suturing, uterine artery embolization) to surgical options, with hysterectomy sometimes required for uncontrolled bleeding in advanced cases.
Rarely, live birth has been reported when the pregnancy extends upward, but such cases are exceptional and high risk.
Frequently Asked Questions
What is a cervical pregnancy?
A cervical pregnancy is a rare ectopic pregnancy where the gestational sac implants within the endocervical canal below the internal os, rather than in the uterine cavity or fallopian tube. This intrauterine-ectopic location carries a high risk of significant bleeding due to the cervix’s vascularity and limited ability to contract.
How common is cervical pregnancy?
Cervical pregnancy is uncommon, comprising less than 1% of all ectopic pregnancies and roughly about 1 in 9,000 pregnancies in broad estimates, reflecting its rarity in clinical practice. Because of its infrequency, misdiagnosis as an incomplete miscarriage can occur without careful imaging criteria.
What are typical symptoms?
The most common presentation is painless vaginal bleeding in early pregnancy, which may range from spotting to heavy hemorrhage. Pain is less typical than in tubal ectopic pregnancy, making bleeding the key clinical clue alongside a positive pregnancy test.
How is it diagnosed?
Transvaginal ultrasound is the primary tool, showing an empty uterine cavity and a gestational sac fixed in the cervix below the internal os, often with peritrophoblastic blood flow on Doppler and absence of the “sliding sign” that suggests miscarriage tissue. MRI can help in equivocal cases or to distinguish from a cesarean scar pregnancy, which sits higher at the scar site above the internal os.
How is it treated and what are the risks?
Management is individualized to control bleeding and preserve fertility when possible, using options such as methotrexate (systemic or local), cervical tamponade or suturing, uterine artery embolization, and selected surgical approaches; hysterectomy may be necessary for uncontrolled hemorrhage. Even with treatment, the condition carries a significant hemorrhage risk, and prompt specialist care is essential to reduce morbidity and protect future reproductive health.
Safe, Comfortable & Joyful Deliveries
Your Birth, Your Comfort, Our Care
At Freya Hospital, we make every delivery safe, comfortable, and joyful — supported by advanced medical expertise and a caring team by our side.