Placental Insertion into the Cervix with Cervical Shortening as a Clinical Sign to Suspect Cervico-Isthmic Pregnancy: A Case Report and Literature Review

Figure 1

(a)–(c) Transvaginal ultrasound findings. (a) Low implantation of the gestational sac and the placenta attached to the posterior wall of the uterus (dotted line) are observed at 7 weeks of gestation. The anterior myometrium including the cesarean scar is intact. (b) The cervical length is 14 mm at 13 weeks of gestation. (c) Placental insertion into the cervix and cervical shortening are noted at 20 weeks of gestation. (d) Magnetic resonance imaging findings at 30 weeks of gestation. Sagittal T2-weighted half Fourier single-shot turbo spin echo (HASTE) sequence images show the insertion of the placenta into the effacement of the cervical canal, intraplacental vasodilatation (white arrowheads), and heterogeneity within the placenta. (e) Surgical specimen of cesarean hysterectomy. A swollen lower uterine segment is noted. (f) and (g) Histopathological finding. (f) White arrowheads indicate the boundaries of the placenta and myometrium. The placenta extensively adhered to the anteroposterior wall from the lower uterine segment to the cervix. (g) The placenta invading the myometrium (dotted line) is observed. The scale bar indicates 500 μm. GS, gestational sac; Cx, cervix; Cor, corpus of the uterus; Pl, placenta; Fd, fundus; Mm, myometrium; Pm, perimetrium.

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