Cervical Ectopic Pregnancy Managed with Methotrexate (original) (raw)
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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...
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.
Conservative management of cervical ectopic pregnancy: systemic methotrexate followed by curettage
Archives of Gynecology and Obstetrics, 2013
Introduction Cervical ectopic pregnancy is among the rarest clinical conditions happening in women of reproductive age. Yet its management can cause a high rate of morbidity. Therefore, conservative treatment of this condition is a matter of debate. Material and methods Hereby we present two cases of cervical ectopic pregnancies that were managed successfully with a conservative approach. Conclusion Cervical ectopic pregnancy can be managed successfully with systemic Metotroxsate followed by curettage.
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.
2000
Cervical ectopic pregnancy is the implantation of a pregnancy in the endocervical canal. Diagnosis and treatment of cervical ectopic pregnancy has changed dramatically in the last 15 years. Before 1980, the diagnosis commonly was made when dilation and curettage for presumed incomplete abortion resulted in unexpected hemorrhage. Emergency hysterectomy usually ensued. Cervical ectopic pregnancy is now commonly diagnosed on a first-trimester ultrasound examination. The family physician practicing obstetrics must consider the diagnosis of cervical ectopic pregnancy in women with first-trimester vaginal bleeding or pelvic pain to permit early diagnosis and fertility-saving treatment. A case report of diagnosis and successful medical management of a cervical ectopic pregnancy is presented. The literature on the epidemiology, causes, diagnosis, and treatment of cervical ectopic pregnancy is reviewed.
A Rare Case Report of Cervical Ectopic Pregnancy
Texila International Journal of Public Health, 2024
Pregnancy that implants in a site outside the uterine cavity is called Ectopic pregnancy. Cervical ectopic pregnancy constitutes only less than 1% of ectopic pregnancies, is potentially life threatening, and treatment on its part is assorting with a great challenge because of possible catastrophic bleeding. The diagnosis of cervical pregnancy can now be made much earlier with the aid of ultrasound and β-human chorionic gonadotropin measurements. Early diagnosis and conservative management with methotrexate can reduce maternal morbidity and mortality.28-year-old gravida 3, para 1, living 1, abortion 1 with a previous caesarean section was seen at 9 weeks and 6 days of amenorrhea with a history of intermittent vaginal bleeding since 4 days and no pain abdomen Ultrasound showed an empty uterine cavity and a gestational sac with cardiac activity located in the cervical canal. Serum beta-human chorionic gonadotropin was significantly elevated to 83,990 mIU/mL. The patient was given methotrexate and leucovorin, supplemented by evacuation and the placement of a Foley catheter for bleeding control. Histopathology confirmed cervical ectopic pregnancy. Serial beta HCG measurements showed a progressive decline, and complete resolution occurred after the institution of multiple doses of methotrexate. Follow-up ultrasound confirmed successful treatment without the risk of surgical intervention (Laparotomy). The most common mode of presentation for cervical ectopic pregnancies is painless vaginal bleeding associated with history of amenorrhea and therefore calls for suspicion of ectopic pregnancy. Early transvaginal ultrasound is mandatory to diagnose ectopic pregnancy. While medical management using methotrexate is very effective, it involves diligent monitoring of beta HCG to guide success and prevent severe complications. The following case illustrates the role of early ultrasound diagnosis and conservative medical management in the treatment of cervical ectopic pregnancy, which may avoid life-threatening haemorrhage and hysterectomy.
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.