Successful Treatment of a Cervical Pregnancy by Single Dose Methotrexate and Vaginal Misoprostol

Cervical pregnancy is an extremely rare form of the ectopic pregnancy. The aim of this case report is to show that single dose methotrexate and vaginal misoprostol could be an alternative therapy to surgery. A 34-year-old, gravida 3, parity 3, patient who had vaginal spotting and 15-day menstrual delay according to her last menstrual cycle, was admitted to our hospital. The serum beta-hCG level of the patient was 23 000 mIU/ml and transvaginal ultrasound revealed a vacancy in the uterine cavity and the localization of the gestational sac in the cervical canal. An embryo with CRL 6.6 mm, with heart-beat, consistent with 6-week and 3-day pregnancy was present. The patient was given a single dose of 50 mg/m(2) methotrexate (85 mg). Four hundred ae g misoprostol was administered to the posterior fornix of the vagina on the second day of the methotrexate therapy, repeating dose of misoprostol was given on the third day as no cervical changes were detected, heart rates were lost on the fifth day and finally abortion was achieved on the eighth day. No major bleeding occurred and no surgical intervention needed. The patient then was followed up by sonographic examinations and serum beta-hCG measurements. This ectopic cervical pregnancy case was treated successfully with a single dose methotrexate and misoprostol. In selected cases single dose methotrexate and misoprostol may become a useful alternative to surgical intervention for the management of viable cervical pregnancy.