Methotrexate and angiographic embolization for conservative treatment of cervical pregnancy.
Cervical pregnancy has traditionally been treated by hysterectomy. Recent reports of the use of methotrexate have been encouraging as a potential conservative approach. We present a case of a cervical pregnancy diagnosed at 8 weeks' gestation in a woman who greatly desired fertility. She was treated successfully with a combination of multidose intramuscular methotrexate (1 mg/kg/day) and citrovorum rescue. When profuse bleeding developed on day 8, angiographic embolization was used to obviate surgery. The beta-hCG titer peaked at 58,362 IU/mL and was undetectable by postchemotherapy day 30. No blood transfusion was required, and reproductive capacity was spared. Four months after the cervical pregnancy, the patient became pregnant and had a healthy infant. Medical management of cervical pregnancy is an option when reproductive capacity is desired in selected patients with appropriate counseling.
Marston
L M
LM
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill 27599-7570, USA.
Dotters
D J
DJ
Katz
V L
VL
D000328:Adult; D000931:Antidotes / Q000008:administration & dosage / Q000627:therapeutic use; D001158:Arteries; D004621:Embolization, Therapeutic; D005260:Female; D005493:Folic Acid Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D005865:Gestational Age; D006801:Humans; D007273:Injections, Intramuscular; D002955:Leucovorin / Q000008:administration & dosage / Q000627:therapeutic use; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000628:therapy*; D014592:Uterine Hemorrhage / Q000628:therapy; D014599:Uterus / Q000098:blood supply
D000931:Antidotes; D005493:Folic Acid Antagonists; D002955:Leucovorin; D008727:Methotrexate