title: Emergency surgical procedure for failed methotrexate treatment of cervical pregnancy: a case report.
abstract: Cervical pregnancy (CP) is a rare and dangerous condition, which may cause a massive haemorrhage. Ultrasonographic diagnosis consists of the visualization of the gestational sac and trophoblastic invasion in an endocervical localization. CP treatment modalities include dilatation and curettage (D&C) usually followed by intracervical tamponade, cervicotomy, angiographic embolization, ligation of the uterine arteries, and chemotherapy with methotrexate (MTX). MTX administration is a very appealing therapeutic modality of CP in the first trimester because of its convenience and efficacy. We report a case of unsuccessful treatment of a CP with systemic MTX administration, which led to an emergency surgical procedure for a sudden massive vaginal haemorrhage. A vaginal ligation of the cervical branches of the uterine arteries was carried out, followed by suction curettage, D&C and insertion of an intrauterine sterile tampon that was removed after 48 hours. The patient did not require a blood transfusion. Histological examination of the specimen confirmed the CP.
authors.affiliation: Department of Obstetrics and Gynaecology, 'Vito Fazzi' Hospital, Lecce, Italy. andtinelli@libero.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Tinelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Malvasi
authors.forename: Daniele
authors.initials: D
authors.lastname: Vergara
authors.forename: Sergio
authors.initials: S
authors.lastname: Casciaro
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000328:Adult; D001158:Arteries / Q000601:surgery; D002584:Cervix Uteri; D006063:Chorionic Gonadotropin / Q000097:blood; D004107:Dilatation and Curettage; D004630:Emergencies; D005260:Female; D006801:Humans; D007558:Italy; D008026:Ligation; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D013630:Tampons, Surgical; D017211:Treatment Failure; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000209:etiology / Q000601:surgery*; D014599:Uterus / Q000098:blood supply
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D008727:Methotrexate