title: The conservative management of cervical ectopic pregnancies.
abstract: OBJECTIVE
  To evaluate the role of conservative management in the treatment of cervical ectopic pregnancies.
  
  
  METHODS
  This was a retrospective analysis of all cervical ectopic pregnancies diagnosed in women attending our early pregnancy unit between April 1997 and September 2004 inclusive. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound. Clinical and demographic data were recorded in all cases. Serum human chorionic gonadotropin levels were measured at presentation and monitored subsequently to determine the rate of successful resolution. Conservative management was in the form of medical or expectant management. Medical management involved administration of systemic or intra-amniotic methotrexate, with or without intra-amniotic potassium chloride. Systemic methotrexate was either a single dose of 50 mg/m2 or an alternate-day regimen of methotrexate at 1 mg/kg (days 1,3,5) with folinic acid rescue (days 2,4,6). If intra-amniotic treatment was required, this was either 50 mg methotrexate or 5 mmol/L potassium chloride.
  
  
  RESULTS
  Seven cervical ectopic pregnancies were diagnosed during the study period. Three cases were managed successfully with a single dose of methotrexate. One case was managed successfully using a multiple-dose methotrexate regimen. Another case failed medical management with both the single- and multiple-dose regimens but was successfully treated after potassium chloride was given intra-amniotically under ultrasound guidance. One case was successfully treated with intra-amniotic methotrexate and another was managed expectantly. There was no associated morbidity or mortality during the study period. We also performed a review of the current literature.
  
  
  CONCLUSIONS
  The conservative management of cervical ectopic pregnancy is effective and safe.
authors.affiliation: Early Pregnancy, Gynaecological Ultrasound and MAS Unit, St George's Hospital Medical School, London, UK. ejkirk@hotmail.co.uk
authors.forename: E
authors.initials: E
authors.lastname: Kirk
authors.forename: G
authors.initials: G
authors.lastname: Condous
authors.forename: Z
authors.initials: Z
authors.lastname: Haider
authors.forename: A
authors.initials: A
authors.lastname: Syed
authors.forename: K
authors.initials: K
authors.lastname: Ojha
authors.forename: T
authors.initials: T
authors.lastname: Bourne
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002584:Cervix Uteri / Q000000981:diagnostic imaging; D006063:Chorionic Gonadotropin / Q000097:blood; D005260:Female; D005328:Fetal Viability; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D011189:Potassium Chloride / Q000627:therapeutic use; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D015415:Biomarkers; D006063:Chorionic Gonadotropin; D011189:Potassium Chloride; D005492:Folic Acid; D008727:Methotrexate