Conservative management of cervical pregnancy with intramuscular administration of methotrexate and KCl injection: Case report and review of the literature

Abstract

We report the case of a cervical pregnancy successfully treated with intramuscular injection of methotrexate (MTX) and intramniotic administration of potassium chloride. A 41-year-old woman was admitted to our Department with the suspicion of ectopic pregnancy. Transvaginal ultrasound revealed empty endometrial cavity, gestational sac within the cervical canal and embryonic echo measuring crown rump length 1.5 mm. Serum beta human chorionic gonadotropine (β-HCG) was measured 28590 IU/L. No cardiac activity was detected. The diagnosis of a cervical pregnancy was made. Patient was treated with intramuscular administration of methotrexate (50 mg/m(2)) in combination with ultrasound-guided intramniotic injection of KCl (2 meq/mL). Gradual decrease of β-HCG levels as well as ultrasound observation of collapsed gestational sac was observed. No curettage was necessitated. Patient was discharged on day 10(th) and was set in follow-up on a weekly basis. β-HCG values were measured < 10 IU/L on 56(th) day after MTX administration. Intramuscular administration of MTX may be effective in treatment of cervical pregnancy without additional interventional measures.

Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls

“…Medical therapy with MTX can be administered systemically via IM injection or directly into the amniotic cavity. MTX may also be supplemented with intraamniotic potassium chloride injection (KCl) to achieve fetal demise [39]. Additional fertility preserving techniques include concomitant use of uterine artery embolization (UAE), balloon tamponade, and endocervical curettage.…”

Two Cases of Ectopic Pregnancy Mimicking Gestational Trophoblastic Disease

“…When sufficient medical treatment is rendered in an ectopic pregnancy, the duration until the pregnancy-related tissue disappears varies from 1 to 6 months [10]. Some researchers report that the lesion vanishes before the serum hCG level becomes negative [11], while other researchers report that conversion to a negative serum hCG level occurs earlier [12]. In case 2, it took approximately 5 months until the remnant tissue was discharged.…”

Cervical Pregnancy: Two Cases with Different Treatment Strategies

“…Cervical pregnancy can be eff ectively treated with methotrexate without the need for D&C [6] . Some authors [10,11] have described a success rate of 81.3% in patients treated with local methotrexate.…”

“…Until now, there has been no consensus regarding the optimal therapeutic approach to CP. However, conservative management based primarily on the use of methotrexate remains the primary protocol [6] . Th is paper describes two cases of CP that were managed successfully with intraembryonic injection of potassium chloride (KCL) in one case and D&C aft er intramuscular methotrexate administration in the other patient.…”