Objective To evaluate conservative management of early viable cervical
pregnancy.
Design Prospective study.
Setting A tertiary teaching hospital.
Population All cases of cervical pregnancies with fetal cardiac activity
presenting to our hospital over six years.
Methods All cases were managed with trans-abdominal intra-amniotic
injection of 25 mg of methotrexate under ultrasound guidance. Follow up
sonographic examinations and serum beta-hCG measurements were performed
every three days. Cervical curettage was performed after two follow up
ultrasound examinations had shown a dead fetus and a regressing
gestational sac as well as declining beta-hCG levels. Patients were
managed as outpatients.
Main outcome measures Successful management and need for
hospitalisation.
Results Nine cases were encountered. Two required a second injection of
methotrexate for persistent fetal cardiac activity and serum beta-hCG
rise in the follow up examination. We did not observe any side effects
and no patient required admission to the hospital.
Conclusions Intra-amniotic methotrexate injection and subsequent
cervical curettage after one week is a successful alternative for the
management of cervical pregnancies
