Result of Conservative Treatment of Cervical Pregnancy with MTX Followed by Therapeutic Curettage

Kim, S M; Kim, B R; Choi, H S; Pyun, J S

Abstract

OBJECTIVE
To evaluate safety and efficacy of intramuscular methotrexate [MTX] followed by dilation and curettage [D & C] for treatment of cervical ectopic pregnancy. METHODS: Five patients with cervical ectopic pregnancies were treated with four doses of intramuscular MTX [1.0 mg/kg] followed by four doses of intramuscular citrovorum factor [0.1 mg/kg] on alternating days. Patients were followed with measurements of serum -hCG [human chorionic gonadotropin] and sonography every third day during MTX treatment. After MTX therapy, therapeutic curettage was done in one week if there was more than 15% decrease of -hCG and measurements of serum -hCG [human chorionic gonadotropin] and sonography were done every week until the level of serum -hCG was normalized.
RESULTS
Three patients showed decreasing titers of serum -hCG after MTX/citrovorum therapy. Two of the five patients showed increasing concentrations of serum -hCG after MTX/citrovorum treatment. After intramniotic injection of MTX, serum -hCG titer was decreased in the cases. one week later, D & C was performed followed by insertion of Foley catheter. All patients did not experience severe bleeding or other untoward effects after D & C.
CONCLUSION
These results suggest that MTX/citrovorum therapy followed by D & C is safe and effective when used as primary therapy for cervical ectopic pregnancy.