Cervical pregnancy treated with transvaginal ultrasound-guided intra-amniotic instillation of methotrexate.
OBJECTIVE
Aim of the study was to investigate the efficacy of single transvaginal ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy with concurrent review of the literature.


METHODS
Six patients with cervical pregnancy are included in the study. All patients were treated with single transvaginal ultrasound-guided intraamniotic installation of 70 mg of methotrexate plus folic acid p.o. The main presenting symptoms were mild to moderate vaginal bleeding and lower abdominal cramp-like pain, resembling the clinical presentation of a threatened abortion. The typical ultrasound findings were the absence of intrauterine gestational sac and the detection of a gestational sac within the cervical canal, invading the anterior or the posterior wall of the cervix and normal appearance of the adnexa, bilaterally. The hourglass-shaped cervix was not characteristic at 5 weeks of gestation but it was at 8 weeks of gestation.


CONCLUSIONS
Ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy appears to be an effective and safe method but the choice of the method should be depended on the gestational age of cervical pregnancy, the presence of active bleeding or not and its severity, the desire for preservation of future fertility, the presence of coexisting valuable intrauterine pregnancy and the experience of the physician in charge.
Hassiakos
D
D
2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Alexandras Avenue 108, 11522 Athens, Greece.
Bakas
P
P
Creatsas
G
G
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000627:therapeutic use; D000650:Amnion; D002584:Cervix Uteri; D005260:Female; D005865:Gestational Age; D006801:Humans; D007322:Instillation, Drug; D008727:Methotrexate / Q000008:administration & dosage* / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate