Successful tubal blastocyst transfer after laparoscopic cervical cerclage: cesarean delivery of a live very low-birth-weight infant and later hysterectomy for uterine rupture.

OBJECTIVE

To report the management of a woman who presented with secondary infertility and amenorrhea after 2 Lletz procedures and a cone biopsy and who had cervical stenosis, a foreshortened cervix, and hematometra.

DESIGN

Case report.

SETTING

Fertility clinic and tertiary hospital.

PATIENT(S): A 34-year-old woman who wanted further children but had had a previous cesarean delivery and then a cone biopsy for cervical intraepithelial neoplasia III that resulted in a foreshortened cervix and cervical obstruction.

INTERVENTION(S): Laparoscopic cervical cerclage, IVF, blastocyst tubal transfer, cesarean delivery, hysterectomy.

MAIN OUTCOME MEASURE(S): Pregnancy; morbidity for the woman and her infant.

RESULT(S): An intrauterine pregnancy occurred after blastocyst intrafallopian transfer, but there was uterine herniation necessitating premature delivery of a very low-birth-weight infant that had lung problems but is now healthy. The mother later developed a hematometra that ruptured, requiring an emergency hysterectomy from which her recovery was protracted.

CONCLUSION(S): This first report of a blastocyst intrafallopian transfer was associated with an intrauterine pregnancy; however, when the indication for blastocyst tubal transfer of an obstructed cervix is associated with a foreshortened cervix requiring cervical cerclage, there can be major health risks for infant and mother.