Treatment of cervical pregnancy with methotrexate

Objectives: To review our experience with early ultrasonographic diagnosis and fertility-preserving complete medical treatment of cervical pregnancy. Methods: From January 1989 to December 1994, 11 cases of cervical pregnancy diagnosed by ultrasonography and treated with methotrexate were evaluated. Patients were treated as follows: systemic administration of methotrexate with leucovorin rescue, a single dose of 50 mg of methotrexate intramuscular injection, or transvaginal ultrasonographically-guided intra-amniotic instillation of 50 mg methotrexate. Results: The mean age of these patients was 33.3 ± 6.2 years and gestational age at diagnosis ranged from 32 to 73 days. The maximal serum β-hCG measured was 135,000 mIU/ml, and the time required for return to normal levels ranged from 20 to 157 days. The ectopic gestation was successfully ablated in all cases, and none required hysterectomy. Conclusion: If a cervical pregnancy is present and diagnosed early, methotrexate treatment, administered either systemically or locally, is effective as the definitive therapy.