Combined treatment of cervical pregnancy with methotrexate and prostaglandins.

Cervical pregnancy is the rarest form of ectopic pregnancy. According to different sources, its incidence varies between 1/1,000 and 1/50,000 [1]. Risk factors for the implantation in the area of the cervical canal can include structural uterine abnormalities, intrauterine adhesions, myomas, as well as a post-traumatic injury to the mucous membrane of the cervical canal. The risk accompanied by cervical pregnancy is related to the interaction of proteolytic enzymes released by the trophoblast on the wall of large blood vessels. This results in massive, life-threatening hemorrhages. Contemporary diagnostic methods, mainly high-resolution ultrasonography, made it possible to implement conservative treatment methods of cervical pregnancies and decrease the proportion of resulting hysterectomies from 90 % to some 15 % [1]. Methods of treatment preserving fertility include systemic or local administration of cytotoxic drugs (methotrexate, actinomycin D, and cyclophosphamide), as well as application of prostaglandin preparations (PGF2-alpha) to the cervical canal in order to prevent severe bleeding.