We read with great interest the article by Fylstra presenting a retrospective series of 13 cases of preoperatively ultrasound-confirmed cervical pregnancies in the first trimester successfully treated by the author’s surgical technique based on suction curettage and balloon tamponade.

We bring to your attention our case of unrecognized cervical pregnancy in the first trimester treated in a way similar to that reported by Fylstra. After gynecologic and ultrasound examination performed under the differential diagnosis of current abortion or spontaneous abortion residua in a 30-year-old woman, G3 P2, with normal obstetric history, we decided to perform dilatation, evacuation, and curettage. However, profuse arterial hemorrhage and clinical picture of obstetric hemorrhagic shock developed during hysterometry and cervical dilatation. As cervical pregnancy was suspected, treatment was continued with suction curettage and cervicovaginal tamponade with a povidone-soaked strip of gauze as urgent procedures, which turned out to be definitive management.

Appreciating the successful preservation surgery technique described by Fylstra, we take this opportunity to note that a considerably simpler surgical procedure (without the use of local hemostatic vasoconstrictive agent and placement of an untied cervical suture, using McDonald cerclage technique) can prove efficient in unrecognized and emergency conditions such as the one described above. Moreover, a combination of suction evacuation and balloon tamponade has proved to be an appropriate therapeutic option even in case of cervical pregnancy complicated by cervical perforation.

On the other hand, our case confirms the statement of Fylstra that on suction curettage, cervical dilatation should not be attempted prior to the insertion of an appropriately sized suction cannula in the cervical canal because further dilatation can lead to immediate and profuse cervical bleeding.