Management of early viable cervical pregnancy

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.