Combined intrauterine and twin cervical pregnancy managed by a new conservative modality

Objective: To describe a rare case of a heterotopic pregnancy with two gestational sacs in the cervix and one in the uterine cavity. Design: Case report. Setting: Tertiary university hospital. Patient(s): A 45-year-old woman was diagnosed with a triplet gestation 7 weeks following IVF treatment for primary infertility of 5 years' duration. Transvaginal ultrasound scan revealed three gestational sacs: one sac inside the uterine cavity containing a live fetus, and two sacs in the uterine cervix, one containing a live fetus and a second empty sac. Intervention(s): Pregnancy termination was performed by selective intraarterial catheterization of the uterine artery, intraarterial administration of methotrexate, and uterine artery embolization with Gelfoam. Main Outcome Measure(s): Intra- or postprocedural complications and fertility preservation. Result(s): The pregnancy termination was successfully performed without intra- or postprocedural complications, with preservation of the patient's fertility. Conclusion(s): Intraarterial methotrexate with uterine vessel embolization is an effective conservative approach to heterotopic cervical pregnancy.