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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:55-61 • 0278-4297

Serial Transvaginal Sonographic Findings of Cervical Ectopic Pregnancy Treated With High-Dose Methotrexate

Mi Jin Song, MD, PhD, Min Hoan Moon, MD, PhD, Jeong-Ah Kim, MD, PhD and Tae Jin Kim, MD, PhD

Departments of Radiology (M.J.S., M.H.M., J.-A.K.) and Obstetrics and Gynecology (T.J.K.), Cheil General Hospital and Women’s Healthcare Center, Kwandong University College of Medicine, Seoul, Korea.

Address correspondence to Mi Jin Song, MD, PhD, Department of Radiology, Cheil General Hospital and Women’s Healthcare Center, Kwandong University College of Medicine, 1-19 Mookjeong-dong, Jung-gu, Seoul 100-380, Korea., E-mail: radsmj{at}msn.com

Objective. We analyzed transvaginal sonographic findings from patients with cervical ectopic pregnancies treated with high-dose methotrexate (MTX). Methods. This was a retrospective analysis of cervical pregnancies diagnosed in our institution from 1996 through 2006. We divided the cases into an MTX treatment group and a surgical treatment group. We included cases treated with high-dose MTX alone. We analyzed 9 cervical ectopic pregnancies treated with MTX, which was injected intravascularly at 100 mg/m2 plus 200 mg/m2 in 500 mL of a normal saline solution with folinic acid rescue. The gestational sac sizes and serum human chorionic gonadotropin (hCG) levels were periodically monitored to determine the resolution status. Results. Fifty cervical pregnancies were diagnosed during the study period. Thirty cases were treated with MTX, and 20 were treated with surgical procedures. Among the 30 cases in the MTX treatment group, 9 had high-dose MTX injection without surgical procedures. Cervical mass regression appeared at a median of 40 (range, 10–88) days after treatment, whereas the serum hCG level decreased at a median of 14 (range, 9–17) days after treatment. The median time to complete regression of the cervical mass was 86 (range, 48–141) days, and the median time to complete regression of the serum hCG level was 68 (range, 19–143) days. Cervical pregnancy was noted as a gestational sac at first but coexisted with a mixed echoic lesion 19 days after treatment. At 33 days after treatment, the cervical pregnancy was completely replaced by the mixed echoic lesion. Conclusions. Resolution of the cervical mass on sonography lagged far behind resolution of the serum hCG level. The cervical mass evolved from a gestational sac into a mixed echoic lesion on serial transvaginal sonography.

Key Words: cervical ectopic pregnancy • methotrexate • transvaginal sonography

Abbreviations: hCG, human chorionic gonadotropin • MTX, methotrexate

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Copyright © 2009 by the American Institute of Ultrasound in Medicine.