Cervical pregnancy

Department of Case Reports New Instruments, Etc.

CHARLES

W.MARSH;

M.D., EAST

(B’rorn

the Department

AND

WALTER

CLEVELAXD,

o,f Obstetrks

and

B.J.

SXIUYLER,

ND.,

OHIO Gynecology,

Hu,ron

Xoad

Hospital)

T IS probable that many early cases of cervical pregnancy are overlooked and are treated as ordinary missed abortions. careful scrutiny will demonstrate a placenta which is firmly attached and breaks up into fragments on attempted removal. The following is a case report of an early cervical pregnancy. Mrs. M. K., a 25-year-old nullipara, was admitted to Huron Road Hospital Jan. 4, 1950, complaining of severe vaginal bleeding. Her past personal history was essentially without event with the exception of a curettage and cauterization of the cervix for cervical erosion in 1948. At this admission her menstrual period was two weeks late. On Dec. 30, 1949), she began to have vaginal spotting which persisted and was accompanied by crampy pains over the lower abdomen. Approximately four to five hours prior to admission vaginal hemorrhage became profuse. On admission to th’e hospital she was in a state of impending Ishock with a thready soft pulse and a blood pressure of 80/50. The red blood count was 3,320,OOO with 56 per cent hemoglobin.

I

Fig.

l.-Drawing

of gross

%XXZX~JIC~

of cervical

~~"~grm!~c~.

The physical examination revealed no significant findings other than marked pallor skin and the previously described signs of acute blood loss. She was transfused with 500 cc. of whole blood, immediately taken to surgery, and The cervix appeared enlarged to twice its normal pelvic examination was performed. size and the arrterior lip bulged with a bluish, somewhat cystic-appearing mass approximately 3 cm. in diameter which overlapped the external OS. of the

407

Curettage was performed and decidualike tissue was obtained. Bleeding was denrolLstrated from the medial surface of the anterior lip. The cystic mass on the anterior lip was excised with a small wedge of the cervical lip to which the growth xvm firmly attached. The raw bleeding base was then cauterized. Following this procedure the patient Is con& tion appeared satisfactory and the postoperative course was without event. Histological examination of the specimen obtained at surgery showed in one area :I mass of placental tissue attached to the surface and extending into the wall of the cervix. There were numerous large and medium-sized viiIi with a few masses of decidual ceIks at the periphery of the pregnancy (Fig. 2).

Fig.

2.-

Placental

tissue

attached

This

to the

wall

of

the

cervix.

case seems to fuElI the criteria laid down by &bin,1 and at approximately one gestation is the earliest cervical pregnancy yet reported, The presence of decidua the contention that the endocervix may undergo &&dual change, thus permitting of the fertilized ovum in the cervical canal. To reconstruct the morphologic sequence of the course of this pregrmncy it seems plausible to assume that the fertilized ovum entered the cervix and became embedded OII the anterior lip. The ovisac. then developed in the wall of the cervix with expansion toward and erosion of the mucosa, terminating by rupture into the cervical canal.

month’s supports nidation

Reference 1. Xubin, 2404

I. C.:

Surg.,

Gynee.

CITD~\R AVENUE.

& Obst.

13:

625, 1911.