Restricted accessCase reportFirst published online 2016-10
Management of Cervical Pregnancy with a Combination of Systemic Methotrexate and Ultrasound-Guided Local Instillation of Methotrexate and Potassium Chloride: A Case Report and Review of the Literature
Background: Cervical pregnancy is a rare and life-threatening obstetric condition. The management options are diverse and have changed over time, focusing on prevention of major hemorrhage along with preservation of fertility. Case: This article presents a case of a cervical ectopic pregnancy in a primigravida without any known risk factors at 5 4/7 weeks of gestation. The patient was given 75 mg of methotrexate (MTX) intramuscularly at 5 5/7 weeks of gestation. Her beta–human chorionic gonadotropin value rose 8% between day 4 and day 7. She was then managed with transvaginal ultrasound–guided local instillation of MTX and potassium chloride (KCL) at 6 4/7 weeks of gestation. Results: She responded well to the combination therapy and did not require any additional procedures. There are only 4 such cases reported in the literature so far, all of whom were treated similarly; the treatment was successful. A review of the literature suggests that this treatment is associated with a better response rate without the need for additional surgical or interventional procedures, reducing the risk of maternal morbidity. Conclusions: A combination of systemic with local medical therapy can be offered as a conservative option for managing cervical pregnancy. (J GYNECOL SURG 32:290)
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