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
Complications:
(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
