Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2015; 3(1): 81-84
Published online Jan 16, 2015. doi: 10.12998/wjcc.v3.i1.81
Conservative management of cervical pregnancy with intramuscular administration of methotrexate and KCl injection: Case report and review of the literature
Stamatios Petousis, Chrysoula Margioula-Siarkou, Ioannis Kalogiannidis, George Karavas, Vasileios Palapelas, Nikolaos Prapas, David Rousso
Stamatios Petousis, Chrysoula Margioula-Siarkou, Ioannis Kalogiannidis, George Karavas, Vasileios Palapelas, Nikolaos Prapas, David Rousso, 3rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 56224 Evosmos, Thessaloniki, Greece
Author contributions: Petousis S and Margioula-Siarkou C wrote the introduction and discussion section; Kalogiannidis I and Karavas G performed the review of literature and wrote the case report; Palapelas V, Prapas N and Rousso D revised the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Stamatios Petousis, MD, MSc, 3rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 56224 Evosmos, Thessaloniki, Greece. petustam@mail.gr
Telephone: +30-69-34050763
Received: July 29, 2014
Peer-review started: July 30, 2014
First decision: September 16, 2014
Revised: October 9, 2014
Accepted: October 28, 2014
Article in press: December 23, 2014
Published online: January 16, 2015
Processing time: 168 Days and 14.9 Hours
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/m2) 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 10th and was set in follow-up on a weekly basis. β-HCG values were measured < 10 IU/L on 56th day after MTX administration. Intramuscular administration of MTX may be effective in treatment of cervical pregnancy without additional interventional measures.

Keywords: Cervical pregnancy; Methotrexate; Effectiveness; Conservative treatment; Intramuscular

Core tip: This case of cervical pregnancy is one amongst few treated successfully with intramuscular administration of methotrexate and intramniotic KCl, without demanding additional interventional treatment. Our paper also summarizes the basic conclusions about conservative treatment of cervical pregnancy, a challenging issue in which no consensus still exists.