June 20th, 2018

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Monochorionic Diamniotic Twin Cervical Ectopic Pregnancy Following Assisted Conception: A Case Report
Authors:  Ivan Anev, M.R.C.O.G., Jean Wang, M.R.C.O.G., Manisha Palep-Singh, M.D., M.R.C.O.G., and Mourad W. Seif, M.D., F.R.C.O.G.
BACKGROUND: Ectopic pregnancy is a leading cause of maternal mortality. Its incidence has progressively increased in recent years. Assisted conception techniques are associated with a significantly higher rate of ectopic pregnancies. Cervical ectopic pregnancies are very rare, accounting for <1% of all ectopic pregnancies.

CASE: A 41-year-old, Caucasian woman presented for routine transvaginal scan at 6 weeks’ gestation following a single embryo transfer as part of in vitro fertilization (IVF) follow-up. This revealed a monochorionic diamniotic twin pregnancy within the cervix. Serum b-hCG concentration was 18,470 IU/L, and she reported only a mild brown-stained vaginal discharge. She was counseled regarding the risks of this pregnancy and was managed medically, receiving oral mifepristone and systemic methotrexate. She was subsequently monitored with serial serum b-hCG measurements and transvaginal ultrasonography. After 6 weeks, due to the slow serum b-hCG decline and lack of spontaneous menstruation, she was counseled regarding the potential risks of the persistent pregnancy and underwent suction evacuation.

CONCLUSION: This case is an example of a complication of IVF. To the best of our knowledge and following a search of the Medline database, this is the only case of monochorionic twin pregnancy located within the cervical canal.
Keywords:  cervical pregnancy, ectopic pregnancy, in vitro fertilization, pregnancy complications, twins
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