Fine needle aspiration of the gestational sac for termination of early pregnancy in cervical stenosis: a case report.

Background: First-trimester abortion in women with cervical stenosis results in difficult or impossible suction curettage. We present the case of an early pregnancy in a woman with cervical stenosis after cone biopsy in which the pregnancy was terminated by transvaginal needle aspiration of the gestational sac under echographic guidance.

Case: A 31-year-old woman, gravida 6, para 3, abortus 2, with a history of grade 3 cervical intraepithelial neoplasia after cervical conization, presented at 6 weeks' gestation and requested pregnancy termination. A cervical examination disclosed that the cervix was difficult to outline and that the external os could not be identified. Under the guidance of endovaginal sonography, a 16-gauge needle was introduced into the gestational sac through the anterior portion of the vagina. Intracardiac injection of potassium chloride was first attempted to stop fetal cardiac activity. The sac tissue was then aspirated, followed by repeated normal saline irrigation. The patient's postoperative course was smooth and was monitored in the outpatient department.

Conclusion: For termination of early pregnancy complicated by cervical stenosis, whether due to blighted ovum, intrauterine fetal death or elective abortion, needle aspiration under the guidance of transvaginal sonography is safe and effective.