CONSERVATIVE TREATMENT OF CERVICAL PREGNANCY Review and case report

Cervikalna trudnoća je najrjeđi, ali i najopasniji oblik ektopične trudnoće. U prošlosti se cervikalna trudnoća liječila kirurškim metodama koje su često završavale histerektomijom. Danas se u terapiji cervikalne trudnoće primjenjuju konzervativne medikamentozne metode. Najčešće korišten lijek je metotreksat. Prikazana je 33-godišnja nulipara koja je primljena u Kliniku zbog klinički i ultrazvučno dijagnosticirane cervikalne trudnoće u 6. tjednu amenoreje. Unutar cerviksa nađen je embrionalni odjek od 4 mm, s pozitivnom srčanom akcijom, a betahCG bio je 9970 IU/L. Započeta je terapija metotreksatom 75 mg iv u infuziji na koju se nadovezala terapija Leukovorinom. Ista terapija je ponavljana 8. i 17. dan. Nakon prve doze betahCG je porastao na 12650 IU/L i potom je kontinuirano padao do 33. dana kada je bio 52,6 IU/L. Pacijentica je 36. dan otpuštena iz bolnice, dva tjedna kasnije je klinički i ultrazvučni nalaz uredan, a betahCG negativiziran.Cervical pregnancy is a rare but very dangerous site of ectopic pregnancy. In the past cervical pregnancy was treated by various surgical methods that often ended with hysterectomy. Today cervical pregnancy is treated conservatively, mainly with local or systemic application of methotrexate. We present a case of 33 years old nullipara who was admitted to our department with clinical and ultrasonographic finding of cervical pregnancy in 6 weeks of gestation. Inside the cervix we found the gestational sac with the embryonic echo 4 mm with positive heart beats. The betaHCG level was 9970 IU/L and we started with administration of methotrexate, 75 mg iv in infusion followed by Leucovorin. The same therapy was given on Day 8 and Day 17. After the first dose of methotrexate betaHCG was higher (12650 IU/L) followed by a continious drop until Day 33 when was 52,6 IU/L. The patient was discharged from the hospital on day 36 and two weeks thereafter had normal clinical and ultrasonographic findings and negative betaHCG