GENERAL GYNECOLOGY Misdiagnosis of cervical ectopic pregnancy Valerie I. Shavell • Mazen E. Abdallah • Mark A. Zakaria • Jay M. Berman • Michael P. Diamond • Elizabeth E. Puscheck Received: 3 March 2011 / Accepted: 29 June 2011 / Published online: 12 July 2011 Ó Springer-Verlag 2011 Abstract Purpose To determine the presenting symptoms as well as the frequency and reasons for the delayed diagnosis of cervical ectopic pregnancy (CEP) in order to increase detection and prevent treatment delay. Methods Retrospective case series of 15 women treated for CEP from January 1997 through December 2008 at a university teaching hospital. Results Fifteen patients were treated for CEP during the study period. Eight patients presented to the emergency department, of which 6 (75%) were initially misdiagnosed. The most common misdiagnosis was threatened miscarriage (n = 5). All patients with accurately diagnosed CEP pre- sented with heavy vaginal bleeding; those misdiagnosed reported mild to moderate vaginal bleeding. Three of six patients misdiagnosed did not have an ultrasound performed upon presentation, and three patients had an ultrasound report not suggestive of CEP. CEP was diagnosed on follow- up ultrasound, delaying treatment 1–4 days. Conclusions Misdiagnosis of CEP upon initial presenta- tion is a common occurrence. Transvaginal ultrasound performed by a qualified practitioner may increase detec- tion and prevent treatment delay. Keywords Cervical pregnancy Á Ectopic Á Diagnosis Á Ultrasound Introduction Cervical ectopic pregnancy (CEP) is a rare but potentially life-threatening medical condition with an incidence of approximately 1 in 1,000 to 1 in 18,000 live births. The exact mechanism of CEP is not known; however, local pathology such as damage to the endocervical canal or endometrial lining is suspected to play a role due to the association of CEP with prior dilation and curettage and cesarean section [1, 2]. Furthermore, CEP is reported to be more frequent in pregnancies achieved via in vitro fertil- ization [3]. Historically, CEP was diagnosed during curettage for presumed incomplete abortion, often resulting in hyster- ectomy due to uncontrollable hemorrhage. Fortunately, the development and implementation of first trimester ultra- sound has permitted the early diagnosis of CEP with accuracy [ 80% [4]. Sonographic criteria of CEP include intracervical localization of a well formed gestational sac (GS), closed internal cervical os, and trophoblastic inva- sion of the endocervical tissue [4]. We were interested in determining the presenting symptoms of CEP as well as the frequency and reasons for the delayed diagnosis of this potentially life-threatening condition. Methods A retrospective study approved by the Institutional Review Board of Wayne State University School of Medicine and V. I. Shavell (&) Á M. E. Abdallah Á M. A. Zakaria Á M. P. Diamond Á E. E. Puscheck Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit Medical Center, 60 W. Hancock Street, Detroit, MI 48201, USA e-mail: vshavell@med.wayne.edu J. M. Berman Division of Gynecology, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit Medical Center, 60 W. Hancock Street, Detroit, MI 48201, USA 123 Arch Gynecol Obstet (2012) 285:423–426 DOI 10.1007/s00404-011-1980-0