DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20204845

Successful conservative management of live cervical ectopic pregnancy: case report

Juhi L. Khithani, Pradnya B. Supe, Meenal S. Sarmalkar

Abstract


Cervical ectopic pregnancy (CEP) is an exceptional type of ectopic pregnancy, representing <1% of the ectopic pregnancy with incidence 1:2500 to 1:12000. It can lead to life threatening complication and torrential bleeding and even necessitate the need for hysterectomy. A 30-year-old patient referred to Lokmanya Tilak Municipal Medical College with transvaginal sonography suggestive of live CEP. Because of patient’s stable condition, it was treated with ultrasound-guided intra-amniotic methotrexate administration. Day 1 β-HCG was 4200 IU/L, day 10 489 IU/L. Gradual decrease of β-HCG levels was coinciding with ultrasonographic finding of absence of gestational sac. During hospitalization, patient reported only minimal vaginal spotting on day 3 of treatment and discharged on day 10 with weekly β-HCG followup. CEP was managed conservatively without surgical intervention, preserving patient’s fertility. Timely detection of CEP and prompt action can save patients fertility with minimal or no surgical intervention.


Keywords


Cervical ectopic pregnancy, Intraamniotic methotrexate injection, Transvaginal ultrasonography, Conservative management

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References


Prameela RC, Dev SV. Cervical ectopic pregnancy: 10 year experience at tertiary care hospital and current literature review. Int J Reprod Contracept Obstet Gynecol. 2016;3:734-42.

Valdez AJ, Flores SEH, Vilchis JAB, Calderon CM. Hysteroscopic treatment of cervical pregnancy: case reportInt J Reprod Contracept Obstet Gynecol. 2020 Apr;9(4):1710-2.

Rock JA, Damario MA. Ectopic pregnancy. In: Rock JA, Jones HW 3rd, editors.

Rubin IC. Cervical pregnancy. Surg Gynecol Obstet 1911;13:625-33.

Paalman RJ, McElin TW. Cervical pregnancy; review of the literature and presentation of cases. Am J Obstet Gynecol. 1959;77:1261-70.

Leeman LM, Wendland CL. Cervical ectopic pregnancy. Diagnosis with endovaginal ultrasound examination and successful treatment with methotrexate. Arch Fam Med. 2000;9:72-7.

Polak G, Stachowicz N, Morawska D, Kotarski J. Treatment of cervical pregnancy with systemic methotrexate and KCI solution injection into the gestational sac – Case report and review of literature. Ginekol Pol. 2011;82:386–9.

Grimbizis G, Chatzigeorgiou K, Tsalikis T, Athanasiadis A, Theodoridis T, Bontis JN. Evacuation of the cervix after methotrexate administration in the treatment of cervical pregnancy: five cases. Reprod Biomed Onlin. 2006;12:487-92.

Tinelli A, Malvasi A, Vergara D, Casciaro S. Emergency surgical procedure for failed methotrexate treatment of cervical pregnancy: a case report. Eur J Contracept Reprod Health Care. 2007;12:391-5.

Weibel HS, Alserri A, Reinhold C, Tulandi T. Multidose methotrexate treatment of cervical pregnancy. J Obstet Gynaecol Can. 2012;34:359-62.

Chen H, Yang S, Fu J, Song Y, Xiao L, Huang W, et al. Outcomes of bilateral uterine artery chemoembolization in combination with surgical evacuation or systemic methotrexate for cervical pregnancy. J Minimal Invasi Gynecol. 2015;22(6):1029-35.

Khatib Y, Khashikar A, Wani R, Patel RD. Cervical ectopic pregnancy: A case report of missed diagnosis. Med J DY Patil Univ. 2016;9:741-3.

Kung FT, Lin H, Hsu TY, Chang CY, Huang HW, Huang LY, et al. Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection. Fertilit Sterili. 2004;81(6):1642-9.

TeLinde's Operative Gynaecology. USA: Lippincott Williams & Wilkins; 2003;9:507-36.

Kaur Pandher D, Shehgal A. Diagnosis and management of cervical ectopic pregnancy- Report of three cases. Nepal Med Coll J. 2009;11:64-5.

Rizk B, Holliday CP, Owens S, Abuzeid M. Cervical and cesarean scar ectopic pregnancies: Diagnosis and management. Middle East Fertil Soc J. 2013;18:67-73.

Yitzhak M, Orvieto R, Nitke S, Neuman-Levin M, Ben-Rafael Z, Schoenfeld A. Cervical pregnancy - A conservative stepwise approach. Hum Reprod. 1999;14:847-9.

Cepni I, Ocal P, Erkan S, Erzik B. Conservative treatment of cervical ectopic pregnancy with transvaginal ultrasound-guided aspiration and single-dose methotrexate. Fertil Steril. 2004;81:1130-2.

Mashiach S, Admon D, Oelsner G, Paz B, Achiron R, Zalel Y. Cervical Shirodkar cerclage may be the treatment modality of choice for cervical pregnancy. Hum Reprod. 2002;17:493-6

Timor-Tritsch IE, Monteagurdo A, Mandeville EO. Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography. Am J Obstet Gynecol. 1994;17:737-9.