Department of Obstetrics and Gynecology, Nasr City Insurance Hospital, Cairo, Egypt.
Department of Radiology, Al-Azhar University, Cairo, Egypt.
Eur J Contracept Reprod Health Care. 2022 Jun;27(3):265-268. doi: 10.1080/13625187.2022.2026325. Epub 2022 Feb 7.
Cervical ectopic pregnancy is rare and has serious haemodynamic implications, usually requiring a hysterectomy. However, the patient's haemodynamic profile and reproductive history may warrant medical management with methotrexate. We present a case report of a 33-year-old primigravida managed conservatively (patient insisted) for cervical ectopic pregnancy.
A 10-weeks pregnant lady suffered from cervical pregnancy as confirmed by ultrasonography with initial β-HCG titre = 65,928 mIU/mL. She received a methotrexate IM-injection followed by multiple transabdominal-ultrasound-guided local doses. Serial sonography to monitor gestational sac size and β-HCG levels were done weekly.
β-HCG levels declined satisfactorily over 4 weeks: 19,166 mIU/mL, 6900 mIU/mL and 1104 mIU/mL on days 14, 21 and 28, respectively. She remained haemodynamically stable throughout admission. On day-35, β-hCG titre reached 400 mIU/mL, and products of conception seen on ultrasound (20 × 25 mm), that were later complicated by secondary infection, necessitated evacuation curettage. β-HCG titre was 2 mIU/mL by 48th day.
Live cervical ectopic pregnancy with high β-hCG titres can be conservatively managed with multidose methotrexate injection administered systemically and locally. However, the efficacy of the applied dose of 25 mg or using higher doses should be evaluated to avoid occurrence of residual lesion.
宫颈妊娠罕见，对血流动力学有严重影响，通常需要子宫切除术。然而，患者的血流动力学状况和生殖史可能需要用甲氨蝶呤进行药物治疗。我们报告了一位 33 岁初产妇经保守治疗（患者坚持）宫颈妊娠的病例。
一位 10 周妊娠的妇女经超声检查证实为宫颈妊娠，β-HCG 初始值为 65928 mIU/mL。她接受了肌内注射甲氨蝶呤，随后进行了多次经腹超声引导局部剂量注射。每周进行超声监测妊娠囊大小和β-HCG 水平。
β-HCG 水平在 4 周内下降满意：第 14、21 和 28 天分别为 19166 mIU/mL、6900 mIU/mL 和 1104 mIU/mL。她在整个住院期间血流动力学稳定。第 35 天，β-HCG 水平达到 400 mIU/mL，超声显示妊娠产物（20×25mm），随后发生继发感染，需要进行清宫术。第 48 天，β-HCG 水平为 2 mIU/mL。
高β-HCG 水平的活宫颈妊娠可以通过系统和局部多次注射甲氨蝶呤进行保守治疗。然而，应评估 25mg 应用剂量或使用更高剂量的疗效，以避免残留病变的发生。
