Combined systemic and intra-amniotic treatment of cervical pregnancy by methotrexate. A report of two cases (original) (raw)
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Cervical ectopic pregnancy successfully treated with local methotrexate injection
Fertility and Sterility, 2008
Objective: To report a case where intra-amniotic injection of methotrexate (MTX) was used to terminate a cervical ectopic pregnancy that was resistant to IM MTX treatment. Design: Case report. Patient(s): A 31-year-old woman, gravida 2, para 1, presented with painless vaginal bleeding. An early cervical pregnancy was diagnosed by transvaginal ultrasound. Intervention(s): Intramuscular MTX therapy was started without success, and an intra-amniotic injection of MTX under ultrasonographic guidance was performed. Main Outcome Measure(s): Pregnancy termination. Result(s): Pregnancy termination was successful, without complications or side effects. Conclusion(s): Local installation of MTX appears to be an effective and safe method; however, choice depends on gestational age, desire to preserve fertility, and, most of all, hemodynamic stability. (Fertil Steril Ò 2008;90:2005.e7-e10.
World Journal of Clinical Cases, 2015
We report the case of a cervical pregnancy successfully treated with intramuscular injection of methotrexate (MTX) and intramniotic administration of potassium chloride. A 41-year-old woman was admitted to our Department with the suspicion of ectopic pregnancy. Transvaginal ultrasound revealed empty endometrial cavity, gestational sac within the cervical canal and embryonic echo measuring crown rump length 1.5 mm. Serum beta human chorionic gonadotropine (β-HCG) was measured 28590 IU/L. No cardiac activity was detected. The diagnosis of a cervical pregnancy was made. Patient was treated with intramuscular administration of methotrexate (50 mg/m 2) in combination with ultrasoundguided intramniotic injection of KCl (2 meq/mL). Gradual decrease of β-HCG levels as well as ultrasound observation of collapsed gestational sac was observed. No curettage was necessitated. Patient was discharged on day 10 th and was set in follow-up on a weekly basis. β-HCG values were measured < 10 IU/L on 56 th day after MTX administration. Intramuscular administration of MTX may be effective in treatment of cervical pregnancy without additional interventional measures.
This case report of a 36-year-old woman with a diagnosis of cervical pregnancy describes a novel approach to this rare form of ectopic pregnancy, which was successfully treated with systemic and local methotrexate (MTX) therapy combined with hysteroscopic resection. After local and systemic administration of MTX, the patient underwent hysteroscopic resection of the cervical pregnancy using a 27 bipolar resectoscope with a 4-mm loop. The cervical pregnancy was completely treated, and satisfactory hemostasis was achieved with electrocoagulation. The reported case and literature review demonstrate that the combination of systemic and local (hysteroscopic) administration of MTX with hysteroscopic resection could offer the possibility of a safe, successful, minimally invasive, and fertility-sparing surgical treatment for cervical pregnancy. ÖZ Servikal gebelik tanısı almış 36 yaşında bir kadın hasta hakkındaki bu vaka sunumunda ektopik gebeliğin, his-teroskopik rezeksiyon ile kombine sistemik ve lokal metotreksat (MTX) ile başarılı bir şekilde tedavi edilmiş olan bu nadir şekline karşı yeni bir yaklaşım tanımlanmaktadır. Lokal ve sistemik MTX uygulaması sonrasında hastaya servikal gebelik için, 4-mm loop ile 27 bipolar rezektoskop kullanılarak histeroskopik rezeksiyon ya-pıldı. Servikal gebelik tamamen tedavi edildi ve elektrokoagülasyon ile yeterli bir hemostaz sağlandı. Yapılan bu literatür taraması ve indeks olgu, sistemik ve lokal (histeroskopik) MTX uygulaması ile histeroskopik re-zeksiyon kombinasyonunun, servikal gebeliğin güvenli, başarılı, minimal düzeyde invaziv ve fertilite-koruyucu cerrahi tedavisinin mümkün olabileceğini göstermektedir. Anahtar Kelimeler: Histeroskopi, metotreksat, servikal gebelik Eurasian J Med 2017; 49: 66-8
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.
Management of cervical ectopic pregnancy after unsuccesful methotrexate treatment
Iranian Journal of Reproductive Medicine, 2014
Background: Cervical pregnancy is rare and dangerous form of ectopic pregnancy which can be treated surgically or conservatively. Methotrexate is reasonable conservative option with high efficiency and acceptable level of side effects. Aim of this paper is to present possible treatment option in case of methotrexate failure, still keeping the postulates of minimal invasive surgery. Case: We describe a case of cervical ectopic pregnancy in nulliparous female that was unsuccessfully treated with single dose, local, ultrasound guided intraamniotic methotrexate. Due to vaginal bleeding caused by remaining products of conception a hysteroscopic resection was performed. Conclusion: Despite the problems that can occur in methotrexate treatment, it is still by far, cheapest and most effective treatment of cervical pregnancies. If necessary, procedure can be combined with other minimal invasive surgical procedures leading to satisfactory results. Hysteroscopic resection has enabled us to rem...
Case Reports in Obstetrics and Gynecology
This study is aimed at describing a noninvasive conservative strategy to the treatment of cervical pregnancy and highlighting the success of ultrasound-guided therapeutic techniques. A 43-year-old woman with a history of one previous cesarean section presented in our unit with vaginal spotting and a positive urine pregnancy test. She was diagnosed with a cervical pregnancy, and she was successfully treated conservatively with the administration of intragestational sac methotrexate under ultrasound guidance. Cervical pregnancy is a rare form of ectopic pregnancy that results from conceptus implantation in the cervical canal. The main concern is the associated life-threatening hemorrhage and subsequent need for urgent hysterectomy. The evolution of ultrasound over the past decades has enabled early diagnosis and has shifted the management from a radical surgical approach towards a stepwise conservative therapeutic approach, when possible.
Treatment of cervical pregnancy with ultrasound‐guided local methotrexate injection
Ultrasound in Obstetrics & Gynecology, 2016
ABSTRACTObjectivesCervical pregnancy (CP) is a rare type of ectopic pregnancy. While methotrexate (MTX) is generally the first‐line method of choice for clinically stable women, there is still no consensus on the most appropriate treatment for this abnormal pregnancy. The aim of this study was to investigate the efficacy of a single local MTX injection under transvaginal ultrasound guidance for the initial treatment of CP and to assess post‐treatment fertility.MethodsWe reviewed retrospectively 15 patients with CP treated with local MTX injection under transvaginal ultrasound guidance. In all patients, the serum human chorionic gonadotropin (hCG) levels were monitored and the gestational sac was evaluated using ultrasonography after treatment. Magnetic resonance imaging (MRI) was performed as necessary. We evaluated the patients' clinical characteristics and clinical course after treatment, the efficacy of the treatment and the post‐treatment fertility in patients desiring subse...
Ultrasonographic appearance of cervical pregnancy following successful treatment with methotrexate
Ultrasound in Obstetrics and Gynecology, 2006
We report a case of cervical ectopic pregnancy successfully treated with systemic methotrexate. Conservative management with single-dose methotrexate was undertaken, but owing to the failure of human chorionic gonadotropin (hCG) levels to fall by 15% by day 7 and the persistence of fetal cardiac activity, two further doses of methotrexate were required. The patient's hCG levels were monitored, and repeat transvaginal ultrasonography was performed until complete resolution of the pregnancy by spontaneous miscarriage. We describe the ultrasonographic findings, which showed that the sac size increased despite treatment.