Management of early viable cervical pregnancy

Objective  To evaluate conservative management of early viable cervical pregnancy. Design  Prospective study. Setting  A tertiary teaching hospital. Population  All cases of cervical pregnancies with fetal cardiac activity presenting to our hospital over six years. Methods  All cases were managed with trans-abdominal intra-amniotic injection of 25 mg of methotrexate under ultrasound guidance. Follow up sonographic examinations and serum β-hCG measurements were performed every three days. Cervical curettage was performed after two follow up ultrasound examinations had shown a dead fetus and a regressing gestational sac as well as declining β-hCG levels. Patients were managed as outpatients. Main outcome measures  Successful management and need for hospitalisation. Results  Nine cases were encountered. Two required a second injection of methotrexate for persistent fetal cardiac activity and serum β-hCG rise in the follow up examination. We did not observe any side effects and no patient required admission to the hospital. Conclusions  Intra-amniotic methotrexate injection and subsequent cervical curettage after one week is a successful alternative for the management of cervical pregnancies.