Patient: Female, 31-year-old Final Diagnosis: Chorioamnionitis Symptoms: Nasal congestion • PPROM • rhinorrhea Clinical Procedure: — Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: Cervical incompetence and deformities contribute significantly to mid-trimester pregnancy losses and preterm births. Abdominal cerclages prevent these complications, particularly in patients with a history of failed vaginal cerclage or severe cervical deformities. However, pregnancy complications such as chorioamnionitis and fetal demise may necessitate cerclage removal. The removal methods vary, with the least invasive being the colpotomy approach, associated with lower morbidity rates than the transabdominal approach or laparoscopy. Case Report: We detail a case involving a 31-year-old woman with a twin pregnancy at 18 weeks gestation, complicated by COVID-19 and chorioamnionitis. This clinical scenario necessitated the removal of an abdominal cerclage. Given the patient's risk profile, a posterior colpotomy approach was deemed most suitable. Conclusions: The posterior colpotomy approach provided an effective and less risky method for abdominal cerclage removal in a high-risk patient. It successfully mitigated the potential complications of general anesthesia and operative risks associated with laparoscopy/laparotomy, offering optimal operative conditions.
Cervical ectopic pregnancies (CEP) are rare, comprising less than 1% of ectopic pregnancies with an incidence of one in 2500 to one in 18000, and 1 to 2.0% of all pregnancies. Due to the rich cervical vascularity and the incompatibility of the cervix to hold an advancing pregnancy, there is a marked increase in the potential of hemorrhage leading to mortality, morbidity, and infertility experienced by the implicated women. There is a divergence of preferences among health care providers for CEP management which ranges from non-surgical methods to hysterectomy. However, a timely diagnosis increases the likelihood of implementing more conservative methods and retaining patients' fertility. New improvements in high-resolution ultrasonography made earlier diagnosis possible, which lead to the development of many conservative treatment approaches that avoid the need for a hysterectomy and preserve fertility. A high index of suspicion, combined with a detailed review of clinical and radiological findings, is essential to make an accurate diagnosis of cervical pregnancy. Our case presents early diagnosis made of a cervical ectopic pregnancy treated medically with the avoidance of surgical intervention and its associated risks. Early diagnosis is essential as it decreases the risks of future infertility and decreases the risk of fatal complications associated with such pregnancies.
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