Ectopic pregnancy (ectopic pregnancy) abstract

Summary

Successful Treatment of a Cervical Pregnancy with Single Dose Methotrexate and Vaginal Misoprostol Cervical ectopic pregnancy is the rarest type of ectopic pregnancies. The aim of this case report is to discuss that a single dose of methotrexate and vaginal misoprostol may be an alternative to surgical treatment in the treatment of cervical ectopic pregnancy. A 34-year-old patient with gravida 3, parity 3, applied to our outpatient clinic with complaints of 15-day delay in menstruation and vaginal spotting according to the last menstrual period. Transvaginal ultrasonography performed on the patient with a β-hCG value of 23 000 mIU/ml revealed that the uterine cavity was empty and the gestational sac was located in the cervical canal. There was only one embryo in the sac with a CRL of 6.6 mm and fetal cardiac activity compatible with 6 weeks and 3 days. A single dose of 50 mg/m2 methotrexate (85 mg) was given to the patient. On the second day after methotrexate treatment, 400 µg/day misoprostol was placed in the posterior fornix of the vagina; In the absence of cervical change, the dose of misoprostol was repeated on the third day, fetal heart rate disappeared on the fifth day, and miscarriage occurred on the eighth day. No serious bleeding occurred and no surgical intervention was required. The patient was followed up with ultrasonography and serum β-hCG measurements. In our case, cervical pregnancy was successfully treated conservatively. Methotrexate and misoprostol may be a good alternative to surgical treatment in selected viable cervical pregnancies.

Abstract

Cervical pregnancy is an extremely rare form of the ectopic pregnancy. The aim of this case report is to show that single dose methotrexate and vaginal misoprostol could be an alternative therapy to surgery. A 34-year-old, gravida 3, parity 3, patient who had vaginal spotting and 15-day menstrual delay according to her last menstrual cycle, was admitted to our hospital. The serum β-hCG level of the patient was 23 000 mIU/ml and transvaginal ultrasound revealed a vacancy in the uterine cavity and the localization of the gestational sac in the cervical canal. An embryo with CRL 6.6 mm, with heart-beat, consistent with 6-week and 3-day pregnancy was present. The patient was given a single dose of 50 mg/m2 methotrexate (85 mg). Four hundred µg misoprostol was administered to the posterior fornix of the vagina on the second day of the methotrexate therapy, repeating dose of misoprostol was given on the third day as no cervical changes were detected, heart rates were lost on the fifth day and finally abortion was achieved on the eighth day. No major bleeding occurred and no surgical intervention needed. The patient then was followed up by sonographic examinations and serum β-hCG measurements. This ectopic cervical pregnancy case was treated successfully with a single dose methotrexate and misoprostol. In selected cases single dose methotrexate and misoprostol may become a useful alternative to surgical intervention for the management of viable cervical pregnancy.

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