Sonographic evolution of a living cervical pregnancy treated with intraamniotic instillation of methotrexate

With the wide availability of TVS, CDI, and quantitative assays for serum beta-HCG, a cervical pregnancy can now be treated more conservatively to preserve the patient's potential fertility.(1-3) Medical treatment with methotrexate, administered either systemically or locally, has been reported to be an effective therapy for a cervical pregnancy when diagnosed early.(3-5) However, the relative changes in the cervical mass containing gestational tissue, uterine size, and peritrophoblastic flow after methotrexate treatment have not been described in detail. We report a case of a living cervical pregnancy treated with intraamniotic instillation of 50 mg of methotrexate under TVS guidance. Serial changes in the TVS and CDI findings, together with the serum beta-HCG levels after treatment, are described.