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

Table 1

Clinical characteristics of cervico-isthmic pregnancy according to gestational age at delivery.

	≤11 weeks of gestation ()		12–21 weeks of gestation ()		≥22 weeks of gestation ()
Gestational weeks at delivery (quartile)	8 (6–9)		17 (16–18)		35.5 (33.25–37)
Imaging findings		n		n		n
	Low implantation of GS	7	Placental insertion into the cervix	3	Low implantation of the gestational sac	5
			Cervical shortening	2	Placental insertion into the cervix	5
					Cervical shortening	6
					Abnormal vascularization	4
					Placental lacunae	4
					Obscurity in placenta-myometrial interface	4
Treatment or delivery method		n		n		n
	MTX	2	MTX → UAE → evacuation by placental forceps	1	Emergency C/S → hysterectomy	7
	MTX → UAE → TCR	2	D&E → evacuation by placental forceps → hysterectomy	1	Caesarean hysterectomy	6
	Misoprostol → D&E → hysterectomy	2	Induced delivery → D&E	1	Elective C/S → hysterectomy	3
	MTX → partial resection by laparotomy	1	Induced delivery → UAE → hysterectomy	1	Vaginal delivery → hysterectomy	3
	Aspiration of GS	1	Induced delivery → hysterectomy	1	Emergency C/S → partial resection	1
	Hysterectomy	1	Hysterectomy	1	Emergency C/S → manual removal	1
					Elective C/S → MTX → UAE → evacuation by placental forceps	1
Blood loss						mL (quartile)
					Total	3,865 (2,880–5,512)
					Elective hysterectomy	3,233 (2,481–4,203)
					Emergency hysterectomy	4,280 (3,500–7,000)
					Others*	2,750 (2,125–3,375)

An article search identified 23 articles (23 patients) in PubMed/Medline and 10 (13 patients) in Ichushi. *: Manual removal of the placenta or partial resection of the lower uterine segment.