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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:959-965 • 0278-4297

Review Article

Successful Management of a Consecutive Cervical Pregnancy by Sonographically Guided Transvaginal Local Injection

Case Report and Review of the Literature

Lauren Ferrara, MD, Victoria Belogolovkin, MD, Manisha Gandhi, MD, Christian Litton, MD, Adam Jacobs, MD, Daniel Saltzman, MD and Andrei Rebarber, MD

Department of Obstetrics, Gynecology, and Reproductive Sciences, Mount Sinai School of Medicine, New York, New York USA.

Address correspondence to Lauren Ferrara, MD, Department of Maternal-Fetal Medicine, Mount Sinai School of Medicine, 5 E 98th St, Second Floor, Box 1171, New York, NY 10029 USA. E-mail: lauren.ferrara{at}mssm.edu

Objective. The purpose of this study was to describe the successful management of a recurrent cervical pregnancy with local injection and to review similarly treated cases to determine adverse outcomes. Methods. A case of a recurrent cervical pregnancy treated with transvaginal local injection was reported. A MEDLINE English language search identified 90 cases of cervical pregnancy treated with local therapy. This literature was analyzed with regard to the various demographic and outcome variables described. Results. Successful use of the transvaginal local approach is described. A review of cases identified a mean maternal age of 33.6 years with a mean gestational age at diagnosis of 7.5 weeks. Bleeding was the most common presenting sign (79%). The mean ß-human chorionic gonadotropin level at the time of diagnosis was 27,798 IU with an average time to resolution of 7.5 weeks. The most common risk factor was a history of curettage (69%), followed by previous cesarean delivery (35%). An additional dose of methotrexate was needed in 6% of cases. Bleeding requiring alternate procedures was present in 5% of cases. There were no complications in 81% of cases. The need for transfusion and development of infection were seen in 3% of cases each. There was 1 case (1.1%) requiring hysterectomy, and no maternal deaths were reported. Conclusions. Conservative management of cervical pregnancy using local injection has been reported to have a low complication rate and a high efficacy for cure.

Key Words: cervical pregnancy • ectopic pregnancy • intra-amniotic • local therapy • methotrexate • potassium chloride

Abbreviations: hCG, human chorionic gonadotropin • KCl, potassium chloride • MTX, methotrexate

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Copyright © 2007 by the American Institute of Ultrasound in Medicine.