Objective: To describe the monitoring of an unsuccessful case of methotrexate treatment of cervical pregnancy.
Design: Case report.
Setting: University hospital.
Patient(s): A 27-year-old woman, gravida 3, para 1, with a vital cervical pregnancy.
Intervention(s): Feticide and methotrexate administered both locally and systemically.
Main outcome measure(s): Treatment success, defined as elimination of the cervical pregnancy with preservation of the uterus.
Result(s): Despite reassuringly declining serum hCG concentrations, several episodes of severe vaginal bleeding demanded transfusions of 19 U of packed cells, two angiographic embolizations that were complicated by septicemia, and a balloon catheter tamponade followed by a third angiographic embolization. Ultimately, a hysterectomy was necessary because of uncontrollable vaginal bleeding.
Conclusion(s): This case report shows that serum hCG monitoring was not helpful in the detection of impending treatment failure. Currently, no guidelines are available to clinicians for predicting treatment failure of methotrexate in patients with cervical pregnancy. Serum hCG clearance curves do enable the timely detection of inadequately declining serum hCG concentrations, for which additional methotrexate can be administered.