Emergency surgical procedure for failed methotrexate treatment of cervical pregnancy: a case report

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.