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

Original Article

Korean Journal of Obstetrics & Gynecology 2001;44(11):2031-2035.
Published online November 1, 2001.

Conservative Treatment of Viable Cervical Pregnancy with Intra-amniotic Methotrexate.

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

Department of Obstetrics and Gynecology, Chungbuk National University Hospital, Chungbuk National University Medical Research Institute, Cheongju, Korea.

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.

Key Words: Cervical pregnancy, fetal cardiac activity, intra-amniotic methotrexate