Cervical Ectopic Pregnancy: Persistence Despite a Serologically Negative β-hCG. A Case Report

Cervical pregnancy is a rare type of ectopic pregnancy that can be associated with significant hemorrhage and loss of fertility. Given its rarity, most effective treatment protocols are not well established.

A 33-year-old primigravid woman at 11 weeks' gestation presented to our institution with a cervical ectopic pregnancy with an initial β-hCG of 114,080 IU/L. She received 2 doses of systemic multidose methotrexate (1 mg/kg) with oral leucovorin on alternating days. Fetal intracardiac potassium chloride injection was also performed. Despite an appropriate decline to undetectable levels of serum β-hCG, as well as resumption of menses, there was persistent sonographic demonstration of the cervical ectopic pregnancy. Surgery was ultimately required to remove the ectopic products of conception.

Despite seemingly successful medical treatment of the cervical ectopic pregnancy with resultant undetectable serum β-hCG levels, surgery was necessary for complete resolution of the cervical pregnancy. This report supports the need to integrate both serum β-hCG levels and ultrasound to ensure complete resolution of these rare pregnancies.