Embarazo ístmico cervical con supervivencia fetal hasta las 32 semanas: reporte de caso

Abstract

Introduction: This clinical case describes a cervico-isthmic pregnancy (CIP), a rare form of ectopic pregnancy with high mortality that is poorly documented in the literature. It provides insights into the diagnosis and management of this condition, which poses a challenge due to the risk of complications such as placental accreta and hemorrhage. The incidence of CIP is approximately 1 in 10,000 pregnancies, and its development into a uterine scar significantly increases the risk to both mother and fetus. Case Presentation: The patient, a 35-year-old woman with a history of cesarean section, presented with two months of amenorrhea and abdominal pain in the hypogastric region. Initial ultrasound evaluation revealed an ectopic pregnancy in the uterine scar. During hospitalization, she experienced a threatened miscarriage, and the diagnosis of CIP was confirmed by magnetic resonance imaging, which showed implantation in the cesarean scar. Definitive Diagnosis, Therapeutic Interventions, and Results: The definitive diagnosis was cervico-isthmic pregnancy, confirmed by ultrasound and magnetic resonance imaging. Treatment was based on bed rest, progesterone, antibiotics, and folic acid supplements. At 32 weeks gestation, a segmental cesarean section with total hysterectomy was performed due to placental accreta and the risk of hemorrhage. A live newborn was delivered without significant complications, and the mother had a favorable recovery. Conclusion: The main lesson of this case is the importance of early diagnosis and interdisciplinary management in advanced ectopic pregnancies in cesarean scars, which improves maternal-fetal outcomes compared to less invasive approaches.