Cervical and Cesarean Scar Pregnancy in One Patient: A Sequential Case with Literature Review.

Background

Cervical pregnancy and cesarean scar pregnancy are rare forms of non-tubal ectopic pregnancy associated with a high risk of severe hemorrhage, surgical intervention, and potential loss of fertility. We describe a unique case of sequential abnormal implantation in which a cervical pregnancy was followed by a cesarean scar pregnancy one year later. The occurrence of two distinct forms of non-tubal ectopic pregnancy in a single patient represents an exceptionally uncommon clinical scenario, underscoring the importance of early diagnosis and carefully planned treatment. Case presentation: A 39-year-old woman, gravida 4 para 3, was diagnosed with two distinct non-tubal ectopic pregnancies over a 1-year period. The first pregnancy was implanted in the cervical canal, whereas the second was located within the cesarean section scar. In each episode, the diagnosis was established early by transvaginal ultrasound. As the patient was hemodynamically stable and wished to preserve fertility, minimally invasive hysteroscopic evacuation was performed in both pregnancies. The procedures were completed without significant intraoperative bleeding, and no additional hemostatic interventions were required. Follow-up serum β-hCG levels became negative after treatment, confirming complete resolution of pregnancies.

Conclusions

This case demonstrates that early ultrasonographic diagnosis and careful individualized management may enable successful fertility-preserving treatment even in exceptionally rare cases. It also supports the potential role of minimally invasive approaches in selected hemodynamically stable patients and highlights the need for standardized management protocols for cervical and cesarean scar pregnancy.