Treatment of cervical pregnancy with ultrasound-guided local methotrexate injection.

Abstract

OBJECTIVES:

Cervical pregnancy (CP) is a rare type of ectopic pregnancy. While methotrexate (MTX) is generally the first-line method of choice for clinically stable women, there is still no consensus on the most appropriate treatment for this abnormal pregnancy. The aim of this study was to investigate the efficacy of a single local MTX injection under transvaginal ultrasound guidance for the initial treatment of CP and to assess post-treatment fertility.

METHODS:

We reviewed retrospectively 15 patients with CP treated with local MTX injection under transvaginal ultrasound guidance. In all patients, the serum human chorionic gonadotropin (hCG) levels were monitored and the gestational sac was evaluated using ultrasonography after treatment. Magnetic resonance imaging (MRI) was performed as necessary. We evaluated the patients' clinical characteristics and clinical course after treatment, the efficacy of the treatment and the post-treatment fertility in patients desiring subsequent pregnancy.

RESULTS:

The median estimated gestational age at the time of MTX injection was 6 + 2 (range, 5 + 2 to 11 + 0) weeks. All 15 patients were treated successfully, without the need for blood transfusion or surgical procedures; however, three patients required an additional local MTX injection due to a poor decline in serum hCG level following the initial injection, while one patient required uterine artery embolization due to persistent vaginal bleeding and an enlarging gestational sac with blood vessels visible on contrast-enhanced MRI. The mean time following initial MTX injection for hCG normalization was 43.8 (95% CI, 33.3-54.3) days and for resumption of menses was 68.4 (95% CI, 51.9-84.9) days. Seven of the 10 women desiring subsequent pregnancy following treatment had uneventful pregnancy, one became pregnant but miscarried spontaneously at 8 weeks of gestation, one was treated by laparoscopic surgery after diagnosis of a tubal pregnancy and one did not conceive.

CONCLUSIONS:

A single, ultrasound-guided, local MTX injection is apparently effective for the treatment of CP without the need for concomitant procedures or surgical intervention. Furthermore, this conservative technique both preserves fertility and allows for the possibility of subsequent uneventful pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

• Authors: M Yamaguchi, R Honda, C Erdenebaatar, M Monsur, T Honda, I Sakaguchi, Y Okamura, T Ohba, H Katabuchi
• Journal: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (Ultrasound Obstet Gynecol) Vol. 50 Issue 6 Pg. 781-787 (Dec 2017) ISSN: 1469-0705 [Electronic] England
• PMID: 27943496 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Chemical References

• Abortifacient Agents, Nonsteroidal
• Methotrexate

Topics

• Abortifacient Agents, Nonsteroidal (administration & dosage)
• Adult
• Cervix Uteri (diagnostic imaging, pathology)
• Female
• Fertility
• Humans
• Methotrexate (administration & dosage)
• Pregnancy
• Pregnancy, Ectopic (diagnostic imaging, drug therapy, pathology)
• Retrospective Studies
• Treatment Outcome
• Ultrasonography, Interventional