A case of cervical ectopic pregnancy: successful therapy with methotrexate.

A 25-year-old lady G2P1L1A0 presented to the emergency room with four-day history of lower abdominal pain and six weeks’ amenorrhea. Her sexual and past medical history was unremarkable. Her previous delivery was by cesarean section. The vital signs were within normal limits. Physical examination was also within normal limits except for mildto-moderate lower abdominal tenderness on palpation without rigidity or guarding. Urine pregnancy test was positive. A transvaginal sonography was performed, which revealed an empty uterus with an endometrial thickness of 13 mm, normal ovaries, and mild probe tenderness in the right fornix and an echolucent area in the cervix with yolk sac suggestive of a gestational sac (Fig. 1). This was confirmed on the 3D scan (Fig. 2). In further evaluating the patient, human chorionic gonadotrophic hormone (b-HCG) was obtained which was elevated at 4,407 mIU/l. Routine blood results were within normal limits. After explaining the risk–benefit ratio, the patient opted for a treatment with methotrexate and 50 mg per square meter of body surface area was administered, intramuscularly. A second dose was given after 1 week as the serum b-HCG levels did not fall. The serum b-HCG levels were followed and displayed in Fig. 3. The serum b-HCG levels reached the normal limits in 5 weeks and a follow-up scan showed complete resolution.