Third trimester fetal death in heterotopic cervical pregnancy: a case report and literature review

Few reports have described the impact of chemical pregnancy on a viable fetus in heterotopic cervical pregnancy. A 38-year-old primigravida was transferred to our hospital with severe abdominal pain at 32 weeks of gestation. She was tentatively diagnosed with placental abruption with intrauterine fetal death (IUFD), and a stillborn fetus was delivered vaginally. Massive vaginal bleeding continued during labor and was uncontrolled after delivery, requiring a hysterectomy. Macroscopic examination revealed a solid nodule in the uterine cervix. Histologically, the nodule consisted of villous tissue. Fluorescent in situ hybridization revealed two placental tissues derived from different embryos, indicating heterotopic cervical pregnancy. Although pregnancy was achieved after double embryo transfer, no early ultrasound findings suggested cervical pregnancy. This is the first report of heterotopic cervical pregnancy in which retained products after a chemical pregnancy caused sudden massive hemorrhage and IUFD in the third trimester.