Successful pregnancy after treatment of cervical pregnancy with methotrexate and curettage. A case report

Cervical pregnancy was diagnosed in a nulliparous, 28-year-old woman who presented with intermittent vaginal spotting at 12 weeks of gestation. Sonographic evaluation revealed a cervical gestational sac with a fetus with cardiac activity. Methotrexate was instilled intraamniotically, followed by an intramuscular injection with folinic acid rescue. On the seventh day of treatment an uneventful curettage was performed because of persistent fetal viability. Five months later pregnancy occurred. The patient vaginally delivered a healthy, 3,080-g neonate at 40 weeks of gestation. To our knowledge, only nine other cervical pregnancies have been managed medically with either methotrexate or etoposide. It seems that first-trimester cervical pregnancies, especially those at less than nine weeks of gestation, can be effectively treated with methotrexate. Successful medical therapy must be considered, not only for regression of the gestation but also for preservation of anatomic integrity and fertility. Four of the above patients, including ours, had a subsequent intrauterine pregnancy, and one of those pregnancies terminated in spontaneous abortion.