Dilday Elizabeth, Douglas Christopher, Brennan Kathleen
University of California, Los Angeles Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, David Geffen School of Medicine, Los Angeles, California, 10833 Le Conte Ave CHS 27-139, Los Angeles, CA 90095, USA.
Case Rep Womens Health. 2021 Jul 8;31:e00340. doi: 10.1016/j.crwh.2021.e00340. eCollection 2021 Jul.
Cervical ectopic pregnancy (CEP) is a rare but potentially life-threatening phenomenon, and conclusive management guidelines have not been elucidated. Patients undergoing assisted reproductive technologies (ART) are at increased risk of CEP and noninvasive, fertility-sparing treatments are necessary for this population. This case report demonstrates the safety and efficacy of a single dose of intramuscular methotrexate for CEP in early gestation.
A 45-year-old patient (G3P0030) presenting with painless vaginal bleeding was found to have CEP on transvaginal ultrasound at 5 weeks and 1 day of gestation after undergoing day-5 frozen embryo transfer. She was given one 50 mg/m dose of intramuscular methotrexate and she remained in a stable condition while being observed in the hospital. Her beta-hCG level decreased 38.2% between day 4 and day 7 after treatment and returned to nonpregnancy levels by day 28.
A single dose of intramuscular methotrexate is an effective, noninvasive, fertility-sparing method of treatment for CEP in patients who are early in gestation and hemodynamically stable. This is a recommended option, especially for those undergoing fertility treatment. Further studies need to be performed to formulate national guidelines regarding the treatment of CEP.
宫颈异位妊娠（CEP）是一种罕见但可能危及生命的现象，目前尚未阐明确凿的管理指南。接受辅助生殖技术（ART）的患者发生CEP的风险增加，因此对于这一群体而言，采用无创且保留生育能力的治疗方法很有必要。本病例报告展示了单剂量肌内注射甲氨蝶呤治疗早期妊娠CEP的安全性和有效性。
一名45岁患者（G3P0030），因无痛性阴道出血就诊，在接受第5天冷冻胚胎移植后妊娠5周零1天时，经阴道超声检查发现为宫颈异位妊娠。她接受了一次50 mg/m剂量的肌内注射甲氨蝶呤，住院观察期间病情保持稳定。治疗后第4天至第7天，她的β - hCG水平下降了38.2%，至第28天恢复到非妊娠水平。
对于妊娠早期且血流动力学稳定的CEP患者，单剂量肌内注射甲氨蝶呤是一种有效、无创且保留生育能力的治疗方法。这是一个推荐的选择，尤其适用于那些正在接受生育治疗的患者。需要进行进一步研究以制定关于CEP治疗的国家指南。
