Cervical pregnancy with massive bleeding after treatment with methotrexate

Abstract

This report describes a catastrophic bleeding following methotrexate treatment of cervical pregnancy and dramatic response to Bakri surgical obstetric silicone (SOS) balloon tamponade in controlling massive bleeding. A 42-year-old woman was diagnosed for cervical pregnancy with a viable fetus at 12 weeks by transvaginal ultrasound. Conservative treatment with intrafetal potassium chloride injection and systemic methotrexate were instituted. On the sixth day of therapy, catastrophic bleeding lead to hypovolemic shock. After resuscitation and blood transfusion, we attempt to control the bleeding with evacuation and curettage but was unsuccessful. Bakri SOS balloon tamponade was applied with immediate and effective response. Nevertheless, total abdominal hysterectomy was performed. In conclusion, conservative treatment of cervical pregnancy with systemic methotrexate could be catastrophic in some patients. Control of active bleeding with Bakri SOS balloon tamponade may possibly be helpful in case of uncontrolled bleeding in selected cases.

Double Balloon Cervical Ripening Catheter for Control of Massive Hemorrhage in a Cervical Ectopic Pregnancy

“…This includes chemotherapy with methotrexate, intra-amniotic feticide, dilation and curettage, uterine tamponade, and uterine artery embolization [ 5 , 6 ]. Usually more than one modality of treatment is necessary [ 2 , 7 ]. We describe a novel method of cervical tamponade using a silicone double balloon cervical ripening catheter (Cook® Cervical Ripening Balloon, Cook Medical, Bloomington, Indiana) in a patient that presented with acute hemorrhage after conservative management with systemic chemotherapy.…”

Cervical Ectopic Pregnancy With Massive Bleeding: A Case Report

“…Saeng-anan et al present a similar case of a cervical pregnancy and massive bleeding. The authors managed to control the bleeding with Bakri surgical, obstetric balloon tamponade temporarily, but, even though, they end up performing a total abdominal hysterectomy as a definitive treatment [11].…”

“…Most authors suggest intrafetal or intra-amniotically potassium chloride (KCl) injection [11,12,17], as well as the combination of local treatment and systemic administration of methotrexate [11].…”

“…More invasive organ-sparing approaches are curettage of the cervical canal and the uterine cavity after methotrexate and KCl administration [17], balloon catheter tamponade [6,11] and uterine artery embolization [18]. The cervix is richly vascularized.…”

The Case of 11w+ 2d Fetal Heart Rate Positive Unruptured Cervical Pregnancy

“…Today, thanks to the use of ultrasound in the last two decades with precise b-hCG measurement ectopic pregnancies including cervical pregnancy can be recognized in early weeks; this lead to conservative approach modalities being discovered [5].…”