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Obstetrics & Gynecology 2007;109:1076-1082
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Transvaginal Ultrasound-Guided Treatment of Cervical Pregnancy

Cherng-Jye Jeng, MD, PhD1, Ma-Lee Ko, MD, MHA2 and Jenta Shen, MD, PhD3

From the 1Department of Obstetrics and Gynecology, School of Medicine, Taipei Medical University, Taipei, Taiwan; 2Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan; and 3Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, California Pacific Medical Center, San Francisco.

OBJECTIVE: To describe our experience with sonographically guided injection of methotrexate and potassium chloride (KCl) to treat early cervical pregnancy.

METHODS: We prospectively reviewed all cases of cervical pregnancies treated conservatively through transvaginal ultrasound-guided therapy at our institutions. Thirty-eight cases were identified, from 1993 through 2004. All cases were managed with transvaginal intra-amniotic and intrachorionic injection of 50 mg of methotrexate under ultrasound guidance. An additional intracardiac fetal injection of 2 mL KCl was given for those cervical pregnancies with documented cardiac activity. Follow-up sonographic examinations and serum ß-hCG measurements were performed twice weekly for 2 weeks after the procedure, then weekly.

RESULTS: The mean initial ß-hCG level was 38,948 milli-International Units/mL and ranged from 5,608 to 103,256 milli-International Units/mL for 22 cases with fetal heart activity and from 2,765 to18,648 milli-International Units/mL for 16 cases without. Gestational age ranged from 5.4 to 14 weeks (mean 8.8 weeks). All cervical pregnancies were successfully aborted, with an average resolution of the cervical mass in 49 days. Postoperative ß-hCG declined to less than 5 milli-International Units/mL within a mean of 38 days. A mean 4.5-year follow-up showed that, of 21 patients who desired pregnancy, 18 had achieved subsequent successful pregnancies.

CONCLUSION: Cervical pregnancies can be successfully managed without surgical intervention through local injection of methotrexate and KCl. This treatment not only ablates the ectopic pregnancy but also preserves the uterus for subsequent pregnancies.

LEVEL OF EVIDENCE: III






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Copyright © 2007 by the American College of Obstetricians and Gynecologists.