Conservative management of a viable cervical ectopic pregnancy with systemic and multiple local methotrexate...

Cervical ectopic pregnancy is rare and has serious haemodynamic implications, usually requiring a hysterectomy. However, the patient's haemodynamic profile and reproductive history may warrant medical management with methotrexate. We present a case report of a 33-year-old primigravida managed conservatively (patient insisted) for cervical ectopic pregnancy.

A 10-weeks pregnant lady suffered from cervical pregnancy as confirmed by ultrasonography with initial β-HCG titre = 65,928 mIU/mL. She received a methotrexate IM-injection followed by multiple transabdominal-ultrasound-guided local doses. Serial sonography to monitor gestational sac size and β-HCG levels were done weekly.

β-HCG levels declined satisfactorily over 4 weeks: 19,166 mIU/mL, 6900 mIU/mL and 1104 mIU/mL on days 14, 21 and 28, respectively. She remained haemodynamically stable throughout admission. On day-35, β-hCG titre reached 400 mIU/mL, and products of conception seen on ultrasound (20 × 25 mm), that were later complicated by secondary infection, necessitated evacuation curettage. β-HCG titre was 2 mIU/mL by 48th day.

Live cervical ectopic pregnancy with high β-hCG titres can be conservatively managed with multidose methotrexate injection administered systemically and locally. However, the efficacy of the applied dose of 25 mg or using higher doses should be evaluated to avoid occurrence of residual lesion.