Conservative Treatment of Cervical Pregnancy with MTX Followed by Therapeutic Curettage

Kang, E J; Kim, H J; Kim, M H; Cho, E N; Kim, H J

Abstract

OBJECTIVE
To evaluate the safety and efficacy of intramuscular methotrexate injection followed by dilatation and curettage (D & C) for the treatment of ectopic cervical pregnancy. METHOD: Nine patients with cervical pregnancy were treated alternately with four doses of intramuscular methotrexate (1.0 mg/kg) and four doses of intramuscular folinic acid (0.1 mg/kg). On the seventh day after treatment, patients were measured for level of serum beta-hCG (human chorionic gonadotropin) and underwent ultrasounds. According to the result, additional dose of MTX or curettage were done. Serum beta-hCG and ultrasound were checked every week until the level of serum beta-hCG and the finding of ultrasound had been normalized.
RESULTS
Eight patients showed normal level in serum beta-hCG and normal finding in ultrasound after the methotrexate/folinic acid therapy followed by D & C. One of nine patients showed increase by double concentrations in serum beta-hCG after the MTX/Folinic acid treatment. After intraamnionic injection of MTX, serum beta-hCG titer was decreased in this case. One week later, D & C was performed. No patient was experienced severe complications. All patients who had wanted a subsequent pregnancy were conceived.
CONCLUSION
These results suggest that methotrexate/folinic acid therapy followed by D & C is safe and effective as a primary therapy for ectopic cervical pregnancy.