Successful Management of Cervical Ectopic Pregnancy with Methotrexate in a Nulliparous Woman: A Case Report

Background and Clinical Significance: Implantation of an embryo in the cervical canal is the rarest location of ectopic pregnancy, as it occurs between 1 in 1000 and 1 in 18,000 pregnancies. Dilation and curettage in previous pregnancies have been identified as risk factors in most cases. Other predisposing factors include pelvic inflammatory disease (PID), prior tubal surgeries, assisted reproductive technologies, as well as the presence of fibroids and intrauterine. Importantly, ectopic pregnancies are the main cause of maternal morbidity and mortality in the first trimester. Given the rarity of cervical ectopic pregnancies (CEPs) and the lack of specific recommendations, clinical data supporting current evidence is of utmost significance. Case Presentation: A 29-year-old nulliparous woman presented with spotting from the genital tract and lower abdominal pain persisting for four days. Pregnancy could not be ruled out based on the patient's medical history. The level of β-Human chorionic gonadotropin (β-HCG) on admission was 1487.99 mIU/mL. The first ultrasonography examination revealed a non-specific imaging appearance suggestive of the presence of cervical mucus. Targeted examination with visualization of the cervical canal revealed a gestational sac measuring 4-5 mm in diameter, containing an embryonic echo. The patient was treated with 84 mg of methotrexate (MTX) i.v. in a 1, 3, 5, 7 scheme along with 0.1 mg/kg calcium folinate i.m. in a 2, 4, 6, 8 scheme prior to curettage. Conclusions: A diagnosis of cervical pregnancy cannot be excluded even in the absence of prior risk factors. Methotrexate should be considered a safe and efficient option in the management of CEP. As shown in our case, early detection of CEP is of utmost significance.