Cervical pregnancy with massive bleeding after treatment with methotrexate (original) (raw)
Related papers
Therapeutic strategies in cervical pregnancy
European Journal of Obstetrics & Gynecology and Reproductive Biology, 1994
Cervical pregnancy is a rare condition associated with a high maternal morbidity rate. Standard recommendations for the management of this ectopic pregnancy are not available. This paper presents a case report and reviews the respective literature. In many cases hysterectomy was the ultimate solution. In order to avoid hysterectomy chemotherapy using methotrexate has been suggested. Local injections of prostaglandins or vasopressin have also been proposed. Based on data collected from the literature and our own experience it is concluded that the management of cervical pregnancy requires individualized therapeutic strategies to minimize the rate of hysterectomies.
Medical management of cervical pregnancy-a report of two cases
Singapore medical journal, 2001
Cervical ectopic pregnancy is a rare life-threatening condition that can be managed conservatively. In this report, the authors describe the use of systemic methotrexate and prostaglandin (sulprostone) in the management of two cases of viable cervical pregnancy. Both cases were successfully treated without the need for surgical intervention.
Ectopic Cervical Pregnancy: Treatment Route
Medicina
Background and objectives: Cervical pregnancy (CP) is a rare form of ectopic pregnancy (EP) in which the embryo implants and grows inside the endocervical canal. Early diagnosis is essential in order to allow conservative medical and surgical treatments. Although many treatment approaches are disponible, the most effective is still unclear. The aim of this study is to evaluate the efficacy of hysteroscopic management in early CP in order to preserve future fertility. Materials and Methods: This is a retrospective observational case series. Five patients with a diagnosis of CP, hemodynamically stables and managed conservatively between 2014 and 2019 at the Institute of Child and Maternal Health Burlo Garofolo in Trieste, Italy, were included. Four patients, with βhCG levels > 5000 mUi/mL were managed by hysteroscopy, with or without a previous systemic Methotrexate (MTX). One case with βhCG levels < 5000 mUi/mL was treated using MTX combined to Mifepristone and Misoprostol. Res...
Cervical pregnancy: A case series and a review of current clinical practice
The European Journal of Contraception & Reproductive Health Care, 2008
Five consecutive cases of cervical pregnancy (CP) are presented. In four cases, the diagnosis was made at routine checkups and these were all treated conservatively. In the fifth case, an erroneous diagnosis of inevitable abortion was made, in a patient presenting with profuse vaginal bleeding. Persistent bleeding following curettage required an emergency hysterectomy, after failure of compressive methods. From the four cases treated conservatively, three received standard methotrexate i.m. (MTX) in combination with bilateral uterine artery embolization (UAE). In one case MTX was followed by intraamniotic puncture and instillation of KCl due to persistent embryonic heartbeat. A spontaneous evacuation of the cervical pregnancy occurred in all patients treated conservatively. We postulate that the preventive use of uterine artery embolization in combination with standard MTX treatment could contribute to reduce the risk of excessive bleeding and facilitate spontaneous expulsion. Possible detrimental effects of the treatment on subsequent reproductive capacities and obstetrical outcome are also pointed out. The diagnostic methods and therapeutic approaches are discussed and the literature is reviewed. With referral to the first case of our series, which required an emergency hysterectomy, we want to stress the importance of an early diagnosis for a correct management of this condition.
The conservative management of cervical ectopic pregnancies
Ultrasound in Obstetrics & Gynecology, 2006
ObjectiveTo evaluate the role of conservative management in the treatment of cervical ectopic pregnancies.To evaluate the role of conservative management in the treatment of cervical ectopic pregnancies.MethodsThis was a retrospective analysis of all cervical ectopic pregnancies diagnosed in women attending our early pregnancy unit between April 1997 and September 2004 inclusive. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound. Clinical and demographic data were recorded in all cases. Serum human chorionic gonadotropin levels were measured at presentation and monitored subsequently to determine the rate of successful resolution. Conservative management was in the form of medical or expectant management. Medical management involved administration of systemic or intra-amniotic methotrexate, with or without intra-amniotic potassium chloride. Systemic methotrexate was either a single dose of 50 mg/m2 or an alternate-day regimen of methotrexate at 1 mg/kg (days 1,3,5) with folinic acid rescue (days 2,4,6). If intra-amniotic treatment was required, this was either 50 mg methotrexate or 5 mmol/L potassium chloride.This was a retrospective analysis of all cervical ectopic pregnancies diagnosed in women attending our early pregnancy unit between April 1997 and September 2004 inclusive. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound. Clinical and demographic data were recorded in all cases. Serum human chorionic gonadotropin levels were measured at presentation and monitored subsequently to determine the rate of successful resolution. Conservative management was in the form of medical or expectant management. Medical management involved administration of systemic or intra-amniotic methotrexate, with or without intra-amniotic potassium chloride. Systemic methotrexate was either a single dose of 50 mg/m2 or an alternate-day regimen of methotrexate at 1 mg/kg (days 1,3,5) with folinic acid rescue (days 2,4,6). If intra-amniotic treatment was required, this was either 50 mg methotrexate or 5 mmol/L potassium chloride.ResultsSeven cervical ectopic pregnancies were diagnosed during the study period. Three cases were managed successfully with a single dose of methotrexate. One case was managed successfully using a multiple-dose methotrexate regimen. Another case failed medical management with both the single- and multiple-dose regimens but was successfully treated after potassium chloride was given intra-amniotically under ultrasound guidance. One case was successfully treated with intra-amniotic methotrexate and another was managed expectantly. There was no associated morbidity or mortality during the study period. We also performed a review of the current literature.Seven cervical ectopic pregnancies were diagnosed during the study period. Three cases were managed successfully with a single dose of methotrexate. One case was managed successfully using a multiple-dose methotrexate regimen. Another case failed medical management with both the single- and multiple-dose regimens but was successfully treated after potassium chloride was given intra-amniotically under ultrasound guidance. One case was successfully treated with intra-amniotic methotrexate and another was managed expectantly. There was no associated morbidity or mortality during the study period. We also performed a review of the current literature.ConclusionThe conservative management of cervical ectopic pregnancy is effective and safe. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.The conservative management of cervical ectopic pregnancy is effective and safe. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.
Case Reports in Obstetrics and Gynecology, 2022
Background. Cervical pregnancy is a rare form of ectopic pregnancy in which the fetus implants and grows inside the endocervical canal. This report aims at introducing a case of successful conservative management of cervical ectopic pregnancy. Case presentation. The patient was a 35-year-old woman, who had received treatment for primary infertility for 5 years. She complained of painless bleeding on day 37 of gestational age with a start point from 10 days before. The patient had stable vital signs and was referred to Shahid Akbar Abadi Hospital in Tehran affiliated with the Iran University of Medical Sciences. In the ultrasonography, the pregnancy sac and the yolk sac with the embryonic pole with a positive fetal heart rate were presented and located near the internal os, so the cervical pregnancy was diagnosed, and after treatment with intramuscular methotrexate and intra-amniotic administration of potassium chloride, a gradual decrease in β-HCG levels was observed without the need for additional interventional treatment. Conclusion. The primary takeaway of our report is that the conservative treatment, including intramuscular methotrexate and intrauterine potassium chloride administration, may be effective in treating cervical pregnancy that can be detected early without the use of curettage.