Ultrasound Guided Monofetal Aspiration and Cerclage Management of Heterotopic Cervical Pregnancy in In Vitro Fertilization Twins

This article reports the management of monofetal heterotropic cervical pregnancy in a twin pregnancy after in vitro fertilization treatment.A 23-year-old female patient with a twin dichorionic diamniotic pregnancy was diagnosed to have a six-weeks old live heterotropic cervical pregnancy and a concomitant intrauterine live pregnancy.She underwent abdominal ultrasound-guided transvaginal monofetal aspiration of the cervical heterotopic pregnancy treatment using a Karman cannula no 6.A double cervical Shirodkar suture was placed to stop active bleeding from the endocervix.After placing the Shirodkar suture on isthmic region and Mc Donald suture on distal cervix, a three cm intrauterine hematoma occurred and resolved within three weeks.The patient delivered uneventfully at 39 weeks of gestation through vaginal route.In such cases, it is possible to surgically terminate the heterotropic pregnancy through transvaginal aspiration under ultrasound guidance and stop cervical bleeding via double cerclage.