Viable cervical pregnancy managed with systemic methotrexate, uterine artery embolization, and local tamponade with inflated Foley catheter balloon

We present an unusual case of a primigravida with a viable cervical pregnancy diagnosed by transvaginal ultrasound and magnetic resonance imaging. Staggered conservative therapeutic measures included systemic high-dose Methotrexate with Folinic acid rescue followed by bilateral embolization of the uterine arteries in response to active cervical bleeding despite declining serum beta-human chorionic gonadotropin levels. Continued active cervical bleeding responded to local tamponade with an inflated Foley catheter balloon positioned within the cervical canal. Conservative treatment was successful, with complete resolution of the cervical pregnancy, resumption of normal menstrual cycles, and a normal transvaginal ultrasonographic appearance of the cervical canal, documented 8 weeks after the initial diagnosis. This case and review of the literature support that various staggered conservative hemostatic measures may be used at various points in which bleeding may occur in the conservative management algorithm of cervical pregnancy.