Methotrexate for cervical pregnancy. A case report.
BACKGROUND
The incidence of cervical pregnancy is 1:1,000-95,000 pregnancies and represents < 1% of all ectopic pregnancies. Evacuation of the pregnancy by curettage does not always stop the bleeding because there is little contractile muscle in the cervix. If there is uncontrollable bleeding, hysterectomy is necessary. In selected cases, nonsurgical management offers high success rates. Among medical treatments, the most common is systemic or local administration of methotrexate.


METHODS
A 36-year-old woman, gravida 2, para 2, presented with vaginal bleeding and subacute pain in the lower abdomen. The patient was 7 weeks' pregnant according to her last menstrual period. Transvaginal ultrasonography showed a gestational sac of approximately 5 weeks' gestational age implanted in the wall of the cervix. Fifty milligrams of methotrexate was injected into the gestational sac and another 50 mg administered intramuscularly. The hCG level decreased continuously and was no longer detectable after 35 days.


CONCLUSIONS
The use of methotrexate for cervical pregnancy is safe and effective and preserves fertility.
Celik
Cetin
C
Department of Obstetrics and Gynecology, Selçuk University Faculty of Medicine, Akyokuş, 42080 Konya, Turkey. celikcet@hotmail.com
Bala
Ayfer
A
Acar
Ali
A
Gezginç
Kazim
K
Akyürek
Cemalettin
C
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000028:Abortion, Induced / Q000379:methods; D000328:Adult; D002584:Cervix Uteri; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D018570:Risk Assessment; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate