Cervical ectopic pregnancy managed with methotrexate and tranexamic acid: A case report

Afr J Med Med Sci. 2014 Dec;43(4):361-4.

Abstract

Background: Cervical pregnancy is a rare life-threatening form of ectopic pregnancy and when it occurs, it is challenging to decide the management options. Surgical intervention has been documented to be complicated by intractable haemorrhage and most often necessitating hysterectomy. We hereby report a case of cervical pregnancy managed conservatively with medical agents prior to surgical intervention. CASE PRESENTATION AND MANAGEMENT: A 29 year old primiparous woman with gestational diabetes mellitus who presented at 10 weeks gestation with 5 days history of brownish vaginal discharge and 2 days history of painless vaginal bleeding. On pelvic examination the cervix was disproportionately larger than the uterus with a closed internal os. Transvaginal and abdominal ultrasound scanning confirmed a live cervical pregnancy. She had intramuscular methotrexate and tranexamic acid followed by suction evacuation combined with balloon tamponade. Examination at 6 weeks post procedure revealed a normal cervix.

Conclusion: Cervical pregnancy still occurs in this environment despite its rarity. Surgical intervention usually results in hysterectomy and adopting medical management as a first line treatment option offers the benefit of uterine preservation.

Publication types

  • Case Reports

MeSH terms

  • Abortifacient Agents, Nonsteroidal / therapeutic use
  • Adult
  • Antifibrinolytic Agents / therapeutic use
  • Cervix Uteri / diagnostic imaging
  • Cervix Uteri / pathology
  • Cervix Uteri / surgery
  • Female
  • Humans
  • Methotrexate / therapeutic use*
  • Organ Sparing Treatments
  • Pregnancy
  • Pregnancy, Ectopic / diagnostic imaging
  • Pregnancy, Ectopic / drug therapy*
  • Pregnancy, Ectopic / pathology
  • Pregnancy, Ectopic / surgery
  • Suction
  • Tranexamic Acid / therapeutic use*
  • Ultrasonography
  • Uterine Cervical Diseases / diagnostic imaging
  • Uterine Cervical Diseases / drug therapy*
  • Uterine Cervical Diseases / pathology
  • Uterine Cervical Diseases / surgery

Substances

  • Abortifacient Agents, Nonsteroidal
  • Antifibrinolytic Agents
  • Tranexamic Acid
  • Methotrexate