Conservative Treatment of Cervical Pregnancy With Methotrexate

Abstract

In cases of first-trimester cervical pregnancy, medical treatment with methotrexate (MTX) should be the first-line of therapy except in patients with heavy bleeding. A cervical pregnancy was diagnosed in a multiparous 31-year-old-woman who presented with intermittent vaginal bleeding at 6 weeks, gestation. Sonography revealed a double uterus and a gestational sac containing a fetus with cardiac activity in the right cervix. Twelve doses of MTX were deliverd intramuscularly, followed by folic acid rescue. Dilatation and curettage was performed on treatment day 42 due to MTX treatment failure. Massive vaginal bleeding occurred during cervical manipulation, and emergent total abdominal hysterectomy was ultimately required. A double uterus and deep trophoblastic invasion of the right cervical wall were proven by pathology.