Findings, case of 38 y/o woman, 7 wks. pregnant w/vaginal bleeding

Imaging Findings

Transabdominal and endovaginal sonograms reveal two gestational sacs, one in the uterus (arrows) and the other in the cervix (arrows). Endovaginal scans with Doppler indicate an embryo in each sac (crown rump length=9mm) with cardiac activity corresponding to a gestational age of 7 weeks.

Management

Under transvaginal sonographic guidance, potassium chloride (KCl) was injected into the cervical embryo causing the heartbeat to stop (arrow). Follow up transabdominal scan confirmed the presence of a normal live intrauterine pregnancy (arrow). Increased echotexture and vascularity was noted in the cervix (arrow). This appearance gradually diminished through the course of the pregnancy; however, the cervix did remain hypervascular. The patient delivered a healthy neonate approximately 7 months later by elective cesarean section.

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