Ectopic preg­nan­cies occur when an embryo implants in the fal­lop­ian tubes, ovary, cervix, or abdomen. I cov­ered fal­lop­ian preg­nan­cies in Part 1 of this series. Part 2 is about preg­nan­cies in the cervix. They are rare, only occur­ring in 0.1% of ectopic preg­nan­cies, and most of them occur after in vitro fertilization.

It’s most typ­i­cal for a cer­vi­cal preg­nancy to abort spon­ta­neously in the first trimester, but those that don’t are prob­lem­atic and dan­ger­ous, espe­cially those that are implanted in the isth­mus— between the cervix and the fun­dus (see dia­gram above)— which are the most com­mon types of cer­vi­cal preg­nan­cies. The first symp­tom of a cer­vi­cal preg­nancy is abnor­mal vagi­nal bleed­ing, but unlike ectopic preg­nan­cies in the fal­lop­ian tubes or ovaries— roughly 2/​3rds of cer­vi­cal preg­nan­cies do not cause cramp­ing or pain. For this, and other rea­sons, cer­vi­cal preg­nan­cies can be hard to iden­tify. Women who don’t go to the emer­gency room at the onset of bleed­ing are espe­cially at risk, so it’s rec­om­mended that women do go to the emer­gency room as soon as abnor­mal vagi­nal bleed­ing begins. A woman who has no med­ical insur­ance and no pain, may wait until she is clearly in cri­sis and the con­se­quences of that can be fright­en­ing— it can threaten her fer­til­ity and her life.

Before imag­ing tech­nol­ogy advances like ultra­sound, cer­vi­cal preg­nan­cies that didn’t spon­ta­neously abort couldn’t be iden­ti­fied until after the woman had been given a hys­terec­tomy to stop the bleed­ing. It was con­firmed after an exam­i­na­tion of the hys­terec­tomized uterus. Now, a cer­vi­cal preg­nancy can be dis­cov­ered even before the woman has symp­toms. If her cervix has a bluish dis­col­oration, for instance, imag­ing can be ordered so that the med­ical team can iden­tify the prob­lem and treat it.

Cer­vi­cal preg­nan­cies before twelve weeks that don’t spon­ta­neously abort and are iden­ti­fied early are the eas­i­est to treat and present less of a threat to a woman’s fer­til­ity and life than those detected and treated later. Imag­ing helps to deter­mine where the preg­nancy is in a woman’s uterus, but it can also be missed. Even with ultra­sound, it can be dif­fi­cult for a med­ical team to dis­tin­guish between a failed or threat­ened mis­car­riage and a cer­vi­cal preg­nancy, espe­cially when the fetus is located a bit higher in the uterus and only par­tially in the cervix.

There are a lot of options for early cer­vi­cal preg­nan­cies that lean toward a con­ser­v­a­tive* approach. For those that con­tinue longer there are many options for treat­ing them. A hys­terec­tomy may be required to stop the bleed­ing when the pla­centa is removed. To under­stand some of the risk of these preg­nan­cies, it’s impor­tant to under­stand that the pla­centa is not just a sack that devel­ops in the uterus— that’s the amni­otic sac that devel­ops inside the pla­centa— the pla­centa is a venous organ that can develop out­side of the uterus. Remov­ing it can cause sig­nif­i­cant and life-​threatening hem­or­rhag­ing. Not remov­ing all of it can cause infec­tion. There is not a spe­cific pro­to­col for treat­ing cer­vi­cal preg­nan­cies after the first trimester. Treat­ing one can be chal­leng­ing even for expe­ri­enced surgeons.

If the woman’s preg­nancy is mis­di­ag­nosed as a threat­ened or failed spon­ta­neous abor­tion, and the woman is sent home to watch and wait, then the woman is at risk of hem­or­rhage. If a woman finds her­self in a Catholic hos­pi­tal that does not allow the use of methotrex­ate or any pro­ce­dure that threat­ens the fetus, she may need to go to another hos­pi­tal for treat­ment, if her future fer­til­ity is impor­tant to her.

As an aside, I found this rec­om­men­da­tion in this article

“CAUTION ! In some soci­eties a woman who does not men­stru­ate is not accept­able as a wife, and if this is so in your com­mu­nity, don’t sac­ri­fice her uterus unless her life is in danger.”

A soci­ety that pri­mar­ily val­ues women accord­ing to their abil­ity to pro­duce chil­dren, doesn’t value infer­tile women enough for their part­ner to remain loyal to them. If you think that that doesn’t have any­thing to do with the beliefs at the root of the “per­son­hood” move­ment, then maybe you’re not pay­ing atten­tion to their implicit mes­sage. We’re get­ting into seri­ous A Handmaid’s Tale ter­ri­tory with “per­son­hood” leg­is­la­tion that defines “per­son­hood” as begin­ning at con­cep­tion and women as incu­ba­tors who are of less value than a life-​threatening mass of cells that has no or astro­nom­i­cally low chances of ever becom­ing viable.
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