• Antonios Koutras, Zacharias Fasoulakis, Michail Diakosavvas, Athanasios Syllaios, Athanasios Pagkalos, Athina A Samara, Georgios Tsatsaris, Thomas Ntounis, Marianna Theodora, Michael Sindos, and Emmanuel N Kontomanolis.
• 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave., 11528 Athens, Greece.
• Medicina (Kaunas). 2021 Sep 15; 57 (9).

AbstractBackground: Ectopic pregnancy is the leading cause of gestation-related deaths during the first trimester. Cervical twin heterotopic pregnancies, when ectopic, constitute a small and rare part of gynecological surgery. Case Presentation: A 30-year-old pregnant woman (gravida 3, para 2) presented with mild pain in the lower abdomen and traces of bleeding per vaginum for three days. Transvaginal ultrasonography revealed a balloon-shaped cervical canal with a visible gestational sac measuring 3.5 × 3.9 cm. A second gestational sac was seen in the uterine cavity. The measurements of the gestational sacs corresponded to 7 + 4 weeks' pregnancy. A decision for medical abortion with mifepristone and misoprostol was made. However, due to an incomplete abortion and continuous bleeding, a curettage was performed. Conclusions: Spontaneous heterotopic pregnancy with the ectopic pregnancy located in the cervix is an extremely rare clinical condition requiring urgent treatment in order to reduce maternal mortality and morbidity and preserve fertility.

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