Management of Cervico-Isthmic Pregnancy with Fetal Death: A Case Report and Considerations for Fertility Preservation

Cervico-isthmic pregnancy (CIP) poses a significant risk for placenta accreta, particularly with advancing gestational age. 

A 33-year-old primigravid woman was diagnosed with CIP and fetal death at 15 weeks gestation. Due to suspected placenta accreta, expectant management was chosen to monitor placental tissue regression. 

After 5 weeks of observation, ultrasonographic findings indicated remission of placenta accreta. Subsequently, a cesarean delivery was performed to terminate the pregnancy, and the uterus was preserved after the complete removal of uterine contents.

CIP carries a high risk of placenta accreta, which can lead to severe perinatal and maternal outcomes. Therefore, appropriate counseling is crucial upon CIP diagnosis, and decisions regarding continuing the pregnancy should be carefully considered. In the event of fetal death during continued pregnancy, expectant management to closely observe placental tissue regression may lead to fertility preservation and favorable maternal prognosis.

Source: Obata S, Shindo R, Otani M, et al. Case Reports in Women's Health. 2023 Jun 1;38:e00501.