Combined Systemic and Hysteroscopic Intra-Amniotic Injection of Methotrexate Associated with Hysteroscopic Resection for Cervical Pregnancy: A Cutting-Edge Approach for an Uncommon Condition

Abstract

This case report of a 36-year-old woman with a diagnosis of cervical pregnancy describes a novel approach to this rare form of ectopic pregnancy, which was successfully treated with systemic and local methotrexate (MTX) therapy combined with hysteroscopic resection. After local and systemic administration of MTX, the patient underwent hysteroscopic resection of the cervical pregnancy using a 27 bipolar resectoscope with a 4-mm loop. The cervical pregnancy was completely treated, and satisfactory hemostasis was achieved with electrocoagulation. The reported case and literature review demonstrate that the combination of systemic and local (hysteroscopic) administration of MTX with hysteroscopic resection could offer the possibility of a safe, successful, minimally invasive, and fertility-sparing surgical treatment for cervical pregnancy.

Management of Cesarean Scar Pregnancy: A Single-Institution Retrospective Review

“…In this regard, several authors in recent years have described the successful hysteroscopic treatment of CSPs in combination with another surgical approach [ 24 ] or medical procedure [ 12 , 25 ] or alone [ 26 ] in early gestational age.…”

Management of Caesarean scar pregnancy with or without methotrexate before curettage: human chorionic gonadotropin trends and patient outcomes

“…The first usage of MTX in the treatment of ectopic pregnancy was reported by Tanaka et al in an interstitial ectopic pregnancy in 1982 [ 4 ]. Recently, MTX has also used in treatment of cervical pregnancy, which is another form of ectopic pregnancy [ 5 ]. CSP is a special type ectopic pregnancy and as such, some researchers have investigated the use of MTX in conservative management or preliminary treatment of CSP prior to curettage [ 6 , 7 ].…”

Commentary on “Assessment of Risk Factors of Intrauterine Adhesions in Patients with Induced Abortion and the Curative Effect of Hysteroscopic Surgery”

“…25,26 The association of this minimally invasive approach with modified instruments and pharmacological medication permits to treat even challenging affections as polypoid formations of big size, cervical pregnancies, and severe bleeding. [27][28][29] Furthermore, a recent study suggests that the hysteroscopy safeness could be incremented by the performance of monitoring some parameters and symptoms during the procedure to prevent and avoid possible complications. 30 Therefore, we concur with the main idea reported by the authors to introduce the hysteroscopy as a valid procedure to treat intrauterine adhesions.…”