Efficacy of methotrexate treatment in viable and nonviable cervical pregnancies

Alternative Treatment Method for Cervical Ectopic Pregnancy

“…[4] In the literature, multiple treatment modalities and conservative approaches have been offered, including systemic or local application of methotrexate, [5,6] local prostaglandin injection in combination with D&C, [7] cervical cerclage, [8] selective uterine artery embolization, [9] D&C and Foley catheter placement, [10,11] and laparoscopic uterine artery ligation and hysteroscopic endocervical resection. [12] As a radical approach, hysterectomy is performed in cases where profuse bleeding threatens life or in patients who are infertile.…”

Cervical ectopic pregnancy: surgical or medical treatment?

“…For conservation of the uterus various therapeutic options are described including surgical ligation of blood vessels or artery embolization [9,[12][13][14], use of a Foley catheter to tamponade the endocervix after dilatation and curettage [13,15,16], cervical cerclage [15,17], and medical management with cytotoxic agents [11,14,[18][19][20][21][22]. A review of the literature shows, although mainly consisting of case reports, that the present treatment standard in asymptomatic CEP is MTX combined with intra-amniotic Fig.…”

“…Second, Hung et al have added two more prognostic factors indicating an elevated risk of treatment failure of MTX: ≥9 weeks gestation and CRL >10 mm [26,27]. On the other hand, a review of the current literature reveals that there are some cases of advanced CEP with poor prognostic factors but an excellent clinical outcome after conservative medical treatment [9,11,22,28,29].…”

Intramural pregnancy embedded in a previous Cesarean section scar treated conservatively

“…We believe that in cases of non-viable intramural pregnancy embedded in a previous Cesarean section scar, treatment with systemic MTX is simple and highly effective 16,17 , even if various side effects have been described 14 . Selective uterine artery angiographic embolization is indicated to prevent and to stop intraoperative bleeding 11 , and when heavy bleeding persists after medical treatment or when there is the suspicion of arteriovenous malformation associated with the ectopic pregnancy 12 .…”

“…Local injection of MTX is usually indicated in viable pregnancies because of its high success rate, its minimal systemic side effects 13,14 and because it allows a more rapid interruption of the pregnancy 3,15,16 . We believe that in cases of non-viable intramural pregnancy embedded in a previous Cesarean section scar, treatment with systemic MTX is simple and highly effective 16,17 , even if various side effects have been described 14 .…”