title: Medical therapy (methotrexate and mifepristone) alone or in combination with another type of therapy for the management of cervical or interstitial ectopic pregnancy.
abstract: OBJECTIVE
  To describe cases of cervical or interstitial ectopic pregnancy managed conservatively with combined medical treatment (methotrexate and mifepristone) alone or in association with other minimally invasive strategies.
  
  
  METHODS
  We describe four cervical and two interstitial ectopic pregnancies at our hospital between 2006 and 2010. All received combined treatment with methotrexate and mifepristone. A search of MEDLINE is also described.
  
  
  RESULTS
  The literature search identified only four previous cases of cervical ectopic pregnancies and no cases of interstitial ectopic pregnancy managed with combined therapy. In our study, all patients were successfully treated and had no adverse reactions with intramuscular methotrexate 50 mg/m² and oral mifepristone 600 mg, either alone or in association with minimally invasive treatment (uterine artery embolization and evacuation dilation and curettage). All patients remained asymptomatic with β-HCG levels that decreased and became negative within 14-49 days: the median hospital stay was 5.5 days. We also describe the first patient with a cervical ectopic pregnancy treated with methotrexate and mifepristone, followed by vaginal misoprostol 800 mcg for cervical evacuation.
  
  
  CONCLUSIONS
  Methotrexate-mifepristone, either alone or in combination with other minimally invasive strategies, could be considered an option for the treatment of both cervical and interstitial ectopic pregnancy. An individualized approach should be used in each patient, however, given the wide variety of possible clinical situations and the potential seriousness of ectopic pregnancy.
authors: Obstetrics and Gynecology Department, Hospital and University Complex of Albacete (SESCAM), Department of Medical Sciences, School of Medicine, Universidad de Castilla La Mancha, Albacete, Spain. tgomezg67@gmail.com
authors: María Teresa
authors: MT
authors: Gómez García
authors: Guadalupe
authors: G
authors: Aguarón Benitez
authors: Beatriz
authors: B
authors: Barberá Belda
authors: Carmen
authors: C
authors: Callejón Rodríguez
authors: Gaspar
authors: G
authors: González Merlo
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D000032:Abortion, Therapeutic / Q000379:methods; D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri; D004107:Dilatation and Curettage; D005260:Female; D006801:Humans; D008727:Methotrexate; D015735:Mifepristone; D009215:Myometrium; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000628:therapy*; D013030:Spain; D055357:Uterine Artery Embolization; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D015735:Mifepristone; D008727:Methotrexate