Uterine artery embolization and local and systemic methotrexate therapy followed by hysteroscopic surgery for management of cervical pregnancy: A case report

Abstract

　Cervical pregnancy is rare (incidence of 1 in 10,000 pregnancies). Uterine artery embolization (UAE), local or systemic methotrexate (MTX) therapy, hysteroscopic surgery, and total hysterectomy are known therapeutic approaches for management of this condition; however, a standard treatment strategy remains unavailable. Cervical pregnancy is therapeutically challenging owing to the high risk of massive bleeding. We report a case of cervical pregnancy accompanied by a fetal heartbeat in a woman with a serum human chorionic gonadotropin (hCG) level as high as 41,033 mIU/mL. Considering the abundant blood flow around the gestational sac, the patient was at a high risk of bleeding and highly resistant to treatment; therefore, she underwent UAE followed by local administration of MTX into the gestational sac. Although the fetal heartbeat disappeared following this treatment, the patient’s blood hCG level on postoperative day 6 remained high at 28,776 mIU/mL; therefore, she was administered systemic MTX. Her blood hCG levels decreased after two doses of systemic MTX; however, pregnant tissue was not spontaneously cleared even after >50 days. Transvaginal ultrasonography showed a gestational sac in the cervix with arterial blood flow around it. Therefore, pregnant tissue was removed hysteroscopically. We report a case of in vitro fertilization and embryo transfer followed by full-term delivery 10 months after hysteroscopic surgery.