Objectives Ectopic pregnancy is one of obstetrics challenge which is associated with high mortality and morbidity. Cervical pregnancy occurs in less than 0.1% of pregnancies. Although extremely rare, it is potentially life-threatening, due to delays in diagnosis and proper management. We aim to discuss a case of cervical ectopic pregnancy which was mistaken as neoplasm.

Methods 32 yo female with profuse vaginal bleeding was referred from a clinician with diagnosis severe anemia and intracervical mass. She admitted positive pregnancy test, of which was pronounced miscarried by the clinician 1 month prior to admission. Our vaginal examination revealed a fragile and easy to bleed cervical mass which was really suggestive of cervical carcinoma or cervical extension of gestational neoplasm. Ultrasound was inconclusive. MRI showed cervical mass, which was later confirmed as conception by cervical biopsy. Methotrexate therapy was given 4 times (1 mg/kgBW). MRI evaluation afterward showed complete resolution.

Results Medical treatment was chosen, using Intravenous methotrexate (MTX, 1 mg/kgBW) combined with Leucovorine (0,1 mg/kgBW). Chemotherapy was given 4 times, every two days interval. One week after treatment, her β-hCG level dropped to normal (0,19 mIU/mL), which was consistent in the following week (0,17 mIU/mL). Repeat imaging studies confirmed the pregnancy resolution.

Conclusions The low incidence of cervical pregnancy in contrary with cervical carcinoma’s incidence in Bali becomes a major obstacle in diagnosing and in the provision of therapy. An accurate history, physical examination and pregnancy test are key modalities in the determination of cervical pregnancy, supported by histopathologic examination, TVS ultrasound examination and MRI.