Hydrodissection as a Novel Alternative After Failed Management of a Cervical Pregnancy With Methotrexate: Case Report and Literature Review

Cervical ectopic pregnancies (CEPs) are rare and life-threatening diagnoses. Risk factors have been associated with CEPs, yet their etiology and pathogenesis remain unknown. Timely intervention is vital for successful outcomes, yet it is challenged as there is no standardized approach to treatment....

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Published inCurēus (Palo Alto, CA) Vol. 16; no. 1; p. e52556
Main Authors Cárdenas-Suárez, Natalia, Urrutia-Villamil, Paulette, Reyes-Jimenez, Taymara, Pereira-Diaz, Olga
Format Journal Article
LanguageEnglish
Published United States Cureus Inc 19.01.2024
Subjects
Case reports
Cervix
Cesarean section
Endometrium
Fertility
Gestational age
Growth factors
Gynecology
Infertility
Obstetrics
Pathogenesis
Pregnancy
Pregnancy complications
Reproductive technologies
Risk factors
Surgery
Ultrasonic imaging
Vagina
methotrexate
ectopic pregnancy
hydrodissection
cervical ectopic pregnancy
cervical pregnancy
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Summary:Cervical ectopic pregnancies (CEPs) are rare and life-threatening diagnoses. Risk factors have been associated with CEPs, yet their etiology and pathogenesis remain unknown. Timely intervention is vital for successful outcomes, yet it is challenged as there is no standardized approach to treatment. We present the case of a 42-year-old woman diagnosed with CEP following five weeks and one day of amenorrhea. The patient was treated with a two-dose regimen of intramuscular methotrexate (MTX) but failed to respond. Ultrasound-guided intrasac MTX injection was considered a secondary treatment. However, spontaneous expulsion was observed after administering lidocaine at different cervical points. Hydrodissection following systemic MTX could present a novel alternative for treating CEP. Expulsion of pregnancy after hydrodissection could be associated with tissue necrosis and/or destabilized implantation of pregnancy, secondary to the effects of MTX. Further research is vital for evaluating the underlying mechanisms for expulsion and the role of hydrodissection following MTX in treating CEP.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.52556