Conservative treatment of a second trimester cervicoisthmic pregnancy diagnosed by magnetic resonance imaging.

Abstract

A cervicoisthmic pregnancy, which may be carried to term, is potentially dangerous for the pregnant woman. With ultrasonographic evaluation alone the diagnosis of a cervical pregnancy in the second trimester is difficult. A nulliparous 33-year-old woman at 21 weeks' gestation was diagnosed by ultrafast T2-weighted magnetic resonance imaging (MRI) to have a cervicoisthmic pregnancy. After the infant was delivered live by cesarean with a vertical fundal incision, methotrexate was infused into the placenta via the umbilical vein. The next day she received uterine artery methotrexate infusion and embolization with platinum coils. Eight months later there was no trace of the placenta on ultrasonography or MRI. She subsequently resumed normal menstrual cycles, conceived, and delivered a healthy infant at term by cesarean after 2 years. This report describes MRI and successful preservation of fertility with such an advanced cervicoisthmic pregnancy.