Inevitable miscarriage mimicking a live cervical ectopic

Case contributed by Dr Alexandra Stanislavsky

Presentation

Bleeding per vagina, elevated beta hCG. No previous ultrasound.

Patient Data

Age: 30 years
Gender: Female

The endometrial cavity is empty.  There is however a gestational sac located within the cervix, which contains a yolk sac and a fetal pole with cardiac activity. No perigestational hemorrhage is seen.

Case Discussion

The finding of a gestational sac within the endocervix has two differentials:  a cervical ectopic, and an inevitable miscarriage.  

On follow-up in this case, products of conception were passed soon after this ultrasound, and a subsequent scan showed an empty uterus and endocervix, confirming the diagnosis of miscarriage.

Nonetheless, this appearance should have a high index of suspicion for a cervical ectopic, which is a potentially more serious diagnosis, with risk of hemorrhage. Furthermore the presence of cardiac activity in an endocervical miscarriage is an unusual feature.  Therefore, despite the final diagnosis of an inevitable miscarriage in this case, this appearance should be managed as a cervical ectopic until proven otherwise.

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Case information

rID: 29009
Published: 26th Apr 2014
Last edited: 14th Aug 2019
System: Obstetrics
Inclusion in quiz mode: Included

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