Description of a case: Bipolar hysteroscopic resection of a cervical ectopic pregnancy with embryonic cardiac activity

Introduction Cervical ectopic pregnancy is a rare form of ectopic gestation associated with a risk of massive haemorrhage, hysterectomy, and impaired reproductive potential. We report a cervical ectopic pregnancy with embryonic cardiac activity managed with bipolar hysteroscopic resection as the sole treatment. Main symptoms and/or clinical findings A 34-year-old primigravida with a spontaneous pregnancy at 6 weeks and 2 days of gestation presented with a 2-day history of scant vaginal bleeding and pelvic pain rated 4/10. She was haemodynamically stable and had no signs of peritoneal irritation. Gynaecological examination showed a posteriorly positioned, long, closed cervix with scant vaginal bleeding and no active haemorrhage. Main diagnoses, therapeutic interventions and results Transvaginal ultrasonography showed an empty uterine cavity and a 16.2-mm cervical gestational sac below the internal cervical os, containing an embryo with a crown–rump length of 6.3 mm, embryonic cardiac activity at 116 beats/min, and a negative sliding sign. The initial serum β-hCG concentration was 8429 mIU/mL. Hysteroscopy identified a 1.0 × 1.5-cm focus of trophoblastic tissue firmly attached to the endocervix. The trophoblastic tissue was resected under direct visualisation using a bipolar loop, with satisfactory haemostasis and no adjunctive treatment. Histopathological examination confirmed first-trimester chorionic villi. Serum β-hCG decreased to 522.76 mIU/mL after 1 week and to <1.2 mIU/mL after 1 month, without complications or reintervention. Conclusion In carefully selected, haemodynamically stable patients diagnosed at an early gestational age, bipolar hysteroscopic resection may enable selective tissue removal, direct haemostatic control, and uterine preservation.