Abstract
Cervical pregnancy is a rare form of ectopic pregnancy, which accounts for less than 1% of all ectopic pregnancies. This case has been reported because of its rarity and successful treatment by methotrexate injection alone, in early viable pregnancy. A 25 year old G3P1L1E1 with history of previous caesarean section and previous abdominal pregnancy, presented with complaints of bleeding per vaginum for 10 days, after 7weeks of amenorrhoea. Transvaginal sonogram showed – single live intrauterine gestational sac with live fetal pole of CRL7.2mm in the cervical stroma, with surrounding increased vascularity. Her Beta-HCG was 53,280mIU/ml. Inj. Methotrexate 70mg i.m was given on Day1,3,5,7 and Inj. Folinic acid 7mg on Day2,4,6,8. Transvaginal ultrasound after 5days showed decrease in vascularity . Ultrasound after 1 week of treatment showed normal uterus and cervix. Beta HCG was 2300mIU/ml. Patient was on follow up with weekly serum beta-HCG. After seven weeks her Beta HCG became normal. Though studies have shown unsatisfactory results using methotrexate for Beta-HCG more than 10,000mIU/ml and cardiac activity is present, in our case we considered methotrexate, because vascularity will be reduced and bleeding will be less when we add other adjuvant conservative procedures. There are also studies showing treatment with methotrexate in viable cervical pregnancy less than12 weeks gestation carrying a high success rate. As with increasing caesarean section and artificial reproductive technique, there is increase in cervical pregnancy, a life threatening event. Early diagnosis allows early intervention and increases the likelihood of successful conservative treatment,there by preserving patient’s fertility. Methotrexate multidose regime as a conservative treatment is found out to be highly successful in viable cervical pregnancy.
Published Version
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