Журнал клинических случаев

Successfully Avoiding Surgery in an Ectopic Cervical Pregnancy.

Abstract

Ayala-Yáñez Rodrigo, López-González Susana and Leroy-Rivera Chantal

The uterine cervix is a rare implantation site for ectopic pregnancy, surgical management should be carefully considered due to the risk of severe hemorrhage associated with this treatment. Methotrexate (MTX) is well documented as an effective medical approach in early gestations and low human chorionic gonadotropin (ß-hCG) levels yielding good results. This is the case,of a 39 year old woman with a 6.5 week old cervical pregnancy. Diagnosis was suspected and later confirmed due to the presence of a late, vaginal hemorrhage and pelvic pain, blood quantitative ß-hCG quantification, clinical exploration and ultrasonographic evaluation. Since the patient was hemodinamically stable and had concerns with her fertility we opted for a medical treatment with MTX in a multiple dose regimen. Treatment was successful after 3 doses (62.5 mg. each, IV infusion), applied on days 1, 3 and 5, using leucovorin (1 g) on alternate days as rescue therapy. Initial ß-hCG levels were reported at 211 mIU/mL, by the time the patient was discharged she had a 77.5% decrease on the ß-hCG levels and diminished symptomatology, after two months follow-up, ß-hCG levels were 0 mIU/mL. Medical management successfully eliminated cervical pregnancy, thus avoiding the risks any invasive procedures may pose.