A case of cervical pregnancy successfully treated with systemic methotrexate administration only and a literature review of cervical pregnancy management

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  • KAWAI Eri
    Department of Obstetrics and Gynecology, Osaka Prefecture Saiseikai Noe Hospital
  • TORI Ayumi
    Department of Obstetrics and Gynecology, Osaka Prefecture Saiseikai Noe Hospital
  • MISE Yuka
    Department of Obstetrics and Gynecology, Osaka Prefecture Saiseikai Noe Hospital
  • NISHIKAWA Takeshi
    Department of Obstetrics and Gynecology, Osaka Prefecture Saiseikai Noe Hospital
  • ISHIKAWA Yukiyoshi
    Department of Obstetrics and Gynecology, Osaka Prefecture Saiseikai Noe Hospital

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Other Title
  • メソトレキサート全身投与のみで治療し得た頸管妊娠の1例
  • 症例報告 メソトレキサート全身投与のみで治療し得た頸管妊娠の1例頸管妊娠に対する治療法の選択 : 自験例と文献的考察
  • ショウレイ ホウコク メソトレキサート ゼンシン トウヨ ノミ デ チリョウ シエタ ケイカン ニンシン ノ 1レイ ケイカン ニンシン ニ タイスル チリョウホウ ノ センタク : ジケンレイ ト ブンケンテキ コウサツ
  • 頸管妊娠に対する治療法の選択―自験例と文献的考察―

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Abstract

<p>Cervical pregnancy is a rare condition with an estimated incidence of 1 in 10000 deliveries. Although total hysterectomy was previously the only effective treatment for cervical pregnancy, the recent development of conservative treatments such as methotrexate (MTX) administration and uterine artery embolization (UAE) preserved fertility. However, given the rarity of the condition, the most effective management method for cervical pregnancy has not been established. Here, we report a case of cervical pregnancy in which fertility was preserved with systemic MTX administration only, and discuss the management of this rare condition in the context of a literature review. The 27-year-old patient was primipara. At seven weeks gestation, transvaginal ultrasonography examination revealed a 14.5 mm gestational sac in the cervical canal with fetal cardiac activity. Cervical pregnancy was diagnosed, and single-dose intramuscular MTX was administered. We recognized the increase in serum hCG level and enlargement of gestational sac at the seventh day, so administered MTX again on the preparation for UAE. After the second MTX administration, the fetus and chorionic villi were spontaneously aborted without excessive bleeding, and the serum hCG level eventually returned to a negative value. Regarding the criteria for MTX therapy for cervical pregnancy, the lack of a therapeutic effect in the presence of fetal cardiac activity and/or high serum hCG level has been reported. However, in some reported cases of fetal cardiac activity and/or high serum hCG level, including the present case, MTX treatment alone was successful. In the analyses of 23 reported cases in the last ten years from the Japanese literature, the therapeutic effect of MTX was not correlated with neither serum hCG levels nor the presence of fetal cardiac activity. Improvement of the ultrasound technology has enabled the early diagnosis of cervical pregnancy, therefore, MTX administration has been also the first line therapy, regardless of fetal heart beat and/or serum hCG level. [Adv Obstet Gynecol, 69 (1) : 8-12, 2017 (H29.2)]</p>

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