Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography

The conservative management of cervical ectopic pregnancies

“…with fetal cardiac activity at presentation): a median of 129 days compared with a median of 43 days. The median number of blood tests to measure serum hCG for each woman was 12 (range, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] and the median number of scans during the period of follow-up was 4 (range, 2-8).…”

“…All women had undergone transvaginal ultrasound, using a 5-MHz probe (Aloka SSD 900 or 2000, Keymed Ltd, Southend, UK and Aloka Co. Ltd., Tokyo, Japan). A cervical ectopic pregnancy ( Figure 1) was diagnosed on sonography if the following criteria were fulfilled: 1) an empty uterus, 2) a barrelshaped cervix, 3) a gestational sac present below the level of the uterine arteries, 4) absence of the sliding sign (when pressure is applied to the cervix using the probe, the gestational sac slides against the endocervical canal in a miscarriage, but does not in an implanted cervical pregnancy) and 5) blood flow around the gestational sac on color Doppler 7,8 .…”

Cervical Ectopic Pregnancy: A Puzzling Event

“…First reported case of cervical case was diagnosed by ultrasonography in 1978 15 . In 1993 Timor-tritsch proposed some tringent criteria 16 . the placenta and entire chorionic sac containing the live pregnancy must be below the internal os, cervical canal must be dilated and barrel shaped.…”

The Treatment of Ectopic Pregnancy with Laparoscopy-Assisted Local Injection of Chemotherapeutic Agents

“…Methotrexate is not yet a first-line treatment for ovarian pregnancy or cesarean scar pregnancy even in candidates who meet the criteria for medical treatment (Bagga, Suri, Verma, Chopra, & Kalra, 2006;Medical treatment of ectopic pregnancy," 2006). However, the use of systemic methotrexate treatment has considered being an option to preserve potential fertility in ectopic pregnancy patients (Hung, Jeng, Yang, Wang, & Lan, 1996;Marcovici, Rosenzweig, Brill, Khan, & Scommegna, 1994;Timor-Tritsch, et al, 1994). Several risk factors have to be evaluated while systemic methotrexate is indicated for the treatment of ectopic pregnancy.…”

“…Based on the finding that etoposide was more effective and had fewer side effects in the management of low-risk gestational trophoblastic tumor, compared to methotrexate treatment (Matsui, et al, 2005), direct injection of etoposide for ectopic pregnancy is considered. Local administration of methotrexate was described in several cases (Hung, et al, 1996;Monteagudo, Minior, Stephenson, Monda, & Timor-Tritsch, 2005;Timor-Tritsch, et al, 1994). On the other aspect, the use of etoposide in ectopic pregnancy is relatively new.…”