A rare site for an ectopic pregnancy is in the endocervical canal. This can present the clinician with challenges in both diagnosis and management.

Because of the location the possibility of a term pregnancy is extremely low.


Any condition that interferes with implantation of a fertilized ovum into the endometrium can result in the implantation into the endocervix (myoma, trauma, in vitro fertilization, etc).


Clinical features:

(1) pelvic or lower abdominal pain

(2) amenorrhea with elevated serum and urine beta-HCG

(3) "hour glass" uterus with demonstration of a gestational sac in the endocervical canal

(4) variable hemorrhage



(1) severe hemorrhage, which may be severe enough to require hysterectomy

(2) loss of fertility secondary to hysterectomy


Conservative management may involve:

(1) administration of methotrexate

(2) arterial embolization

(3) arterial ligation (bilateral anterior trunk of the internal iliac arteries, other)

(4) curettage

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