Optimizing Outcomes Using Multimodal Therapy: Persistent Cervical Ectopic Pregnancy with Cardiac Motion

Abstract

Background:

Cervical ectopic pregnancy (CEP) is a rare diagnosis with few reported cases, making establishment of a standardized treatment challenging. CEPs often require multiple therapeutic modalities and curative surgical management.

Case:

A patient in her late 40s presented with a persistent CEP after in-vitro fertilization (IVF). Initially, the ectopic pregnancy was treated with ultrasound-guided needle aspiration and multiple doses of methotrexate, but further approaches were necessary to resolve the case.

Results:

This patient had a CEP with a heartbeat and she had a very high β–human chorionic gonadotropin (β-hCG level). She initially responded appropriately to repeat doses of methotrexate and needle aspiration, but her β-hCG levels eventually plateaued. Eventually, definitive suction curettage, vasopressin injection, and an intracervical Foley balloon tamponade provided a successful resolution.

Conclusions:

This case highlights further how multimodal treatment methods are valuable for safe resolution of CEPs. The patient at first responded appropriately to multiple doses of methotrexate, which decreased her surgical risks and morbidity significantly. (J GYNECOL SURG 40:44)