Conservative management of a viable cervical ectopic pregnancy with systemic and multiple local methotrexate injections. A case report

Abstract

Purpose

Cervical ectopic pregnancy is rare and has serious haemodynamic implications, usually requiring a hysterectomy. However, the patient’s haemodynamic profile and reproductive history may warrant medical management with methotrexate. We present a case report of a 33-year-old primigravida managed conservatively (patient insisted) for cervical ectopic pregnancy.

Materials and methods

A 10-weeks pregnant lady suffered from cervical pregnancy as confirmed by ultrasonography with initial β-HCG titre = 65,928 mIU/mL. She received a methotrexate IM-injection followed by multiple transabdominal-ultrasound-guided local doses. Serial sonography to monitor gestational sac size and β-HCG levels were done weekly.

Results

β-HCG levels declined satisfactorily over 4 weeks: 19,166 mIU/mL, 6900 mIU/mL and 1104 mIU/mL on days 14, 21 and 28, respectively. She remained haemodynamically stable throughout admission. On day-35, β-hCG titre reached 400 mIU/mL, and products of conception seen on ultrasound (20 × 25 mm), that were later complicated by secondary infection, necessitated evacuation curettage. β-HCG titre was 2 mIU/mL by 48th day.

Conclusions

Live cervical ectopic pregnancy with high β-hCG titres can be conservatively managed with multidose methotrexate injection administered systemically and locally. However, the efficacy of the applied dose of 25 mg or using higher doses should be evaluated to avoid occurrence of residual lesion.

摘要

目的：宫颈异位妊娠很少见, 对血流动力学有严重影响, 通常需要进行子宫切除术。然而, 患者的血流动力学特征和生育史可能需要使用甲氨蝶呤进行医疗管理。我们报告了一个 33 岁的初产妇对宫颈异位妊娠进行保守治疗（患者坚持）的病例报告。

材料和方法：一名怀孕10周的女性宫颈妊娠经超声检查证实, 初始β-HCG 滴度＝65,928 mIU/mL。她接受了甲氨蝶呤肌肉注射, 然后是多次经腹超声引导的局部注射。每周进行连续超声检查以监测妊娠囊大小和β-HCG 水平。

结果：β-HCG 水平在 4 周内令人满意地下降：第 14、21 和 28 天分别为 19,166 mIU/mL、6900 mIU/mL 和 1104 mIU/mL。在整个入院期间, 她的血流动力学保持稳定。在第35天, β-hCG 滴度下降至400 mIU/mL, 超声上可见(20 × 25mm)受孕产物, 后因继发感染, 需要清宫手术。到第 48 天, β-HCG 滴度为 2 mIU/mL。

结论：具有高β-hCG 滴度的宫颈异位妊娠可以通过全身和局部多剂量甲氨蝶呤注射液进行保守治疗。然而, 应评估使用25mg剂量或使用更高剂量的疗效, 以避免发生病变的残留。

Keywords:

• Cervical ectopic
• local
• methotrexate
• multiple-dose
• trans-abdominal
• ultrasound-guided
• viable

Disclosure statement

No potential conflict of interest was reported by the author(s).