Conservative Treatment of Viable Cervical Pregnancy with Intra-amniotic Methotrexate

Sin, Seo Kyu; Yoon, Tae Jin; Hong, Seung Hwa; Kim, Yong Beom; Ji, Ill Woon; Jeong, Eun Hwan; Kim, Hak Soon

Abstract

OBJECTIVE
The purpose of this study was to determine the effectiveness of intra-amniotic methotrexate instillation for the treatment of viable cervical pregnancy.
MATERIALS AND METHODS
Four patients were enrolled in this study after confirmation of cervical pregnancy by ultrasonography. Viable cervical pregnancy was determined by ultrasonographic findings with the entire chorionic sac containing a live fetus below the internal os, empty uterine cavity, and significantly dilated or barrel shaped cervical canal. Under the transvaginal ultrasonographic guidence, 50 mg of methotrexate was injected directly into the amniotic sac after complete aspiration of amniotic fluid. Serial serum beta-human chorionic gonadotropin (beta-hCG) was evaluated weekly until normalized.
RESULTS
All the patients were successfully treated with conservative method and one patient received hysterectomy due to arterio-venous malformation diagnosed during follow up. Initial serum beta-hCG concentration was 22,484-93,803 mIU/ml and decreased by log scale after treatment.
CONCLUSION
Intra-amniotic methotrexate instillation without concomitant feticide injection or feticidal procedure can be used for the initial treatment in viable cervical pregnancy. Initial titer or falling rate pattern of serum beta-hCG did not seem to be related with the prognosis.