Dados do Trabalho

Title

Treatment of cervical ectopic pregnancy with methotrexate in a patient with recurrent ectopic pregnancy: a case report.

Objective

To evaluate the efficacy and safety of the treatment of cervical ectopic pregnancy with the use of methotrexate (MTX) in a patient with recurrent ectopic pregnancy.

Methods

Report of a patient who had three ectopic pregnancies, the last being a cervical ectopic pregnancy. The diagnosis was made based on clinical examination and confirmed by ultrasonography, which identified the presence of a gestational sac with an embryo in the cervix. The treatment adopted for this patient was the use of MTX, a drug that interferes with the growth and development of embryonic cells, inducing the termination of ectopic pregnancy. In this case, the administration of MTX was chosen as a non-surgical alternative, aiming to avoid invasive procedures and preserve the patient's fertility. Regular follow-ups of beta-hCG levels to prepregnancy values were performed.

Results

Cervical ectopic pregnancy is regarded as an exceptional location, accounting for less than 1% of ectopic pregnancies. Although rare, this is the most serious and dramatic obstetric pathology. E.V.M., a 28-year-old female patient with no previous history of pathology sought gynecological care due to complaints of infertility after six years of unsuccessful attempts. The patient reports having had two miscarriages in the year 2020, the first being an ectopic pregnancy in May 2019, which required a right salpingectomy, and the second an abortion with curettage performed in August 2019 at 5 weeks gestation.
Despite the previous abortions, the patient had no changes on physical and gynecological examination. However, laboratory tests revealed altered anti-cardiolipin antibody and the presence of positive antinuclear factor, indicating possible immunological or autoimmune disorders.
In June 2022, the patient returned to the clinic to undergo an in vitro fertilization cycle. After the transfer of two devitrified embryos, the patient presented with a twin pregnancy, with one intrauterine gestational sac and the second right ectopic gestational sac with a positive fetal heartbeat. As a result, the patient needed to undergo a right total salpingectomy to remove the ectopic gestational sac. The intrauterine pregnancy proceeded without complications, resulting in a full-term delivery.
In March 2022, the patient returned to the service with the desire to perform a
second embryo transfer. However, this pregnancy resulted in an abortion.
In April 2022, the patient returned again for her last embryo transfer of her last embryo, resulting in a single pregnancy with cervical implantation. The treatment performed to induce the abortion was with three cycles of MTX. After the use of the medication, there was a regression of beta-hCG to pre-pregnancy values, indicating the resolution of the cervical ectopic pregnancy.

Conclusion

The use of MTX is an effective alternative treatment for cervical ectopic pregnancy. This non-surgical approach has the advantage of preserving the patient's fertility while avoiding the need for invasive procedures.

Keywords

Ectopic pregnancy, methotrexate, cervical ectopic pregnancy.