Abstract
Cervical ectopic pregnancy is an extremely rare condition with catastrophic sequelae if timely, appropriate management is not performed. Some risk factors predispose patients to this condition, but in our case, no predisposing risk factors were present. Nulliparity and young age are the most challenging points for fertility conservation, and multimodal conservative management is a highly successful option for appropriately selected patients.
A 22-year-old nulliparous patient presented to our tertiary university hospital for a viable 8-week cervical ectopic pregnancy after failure of treatment with two doses of methotrexate. Confirmation of the diagnosis was achieved, and our team selected a multimodal conservative management approach. During admission, severe bleeding was recognized early on, and the patient was successfully handled with satisfactory fertility preservation outcomes.
Fertility preservation is the most challenging point when dealing with cervical ectopic pregnancy, especially in young nulliparous women. However, the best way to manage cervical ectopic pregnancy has not yet been confirmed, and multimodal conservative management can be an effective method.
References
1. Vela G, Tulandi T. Cervical pregnancy: the importance of early diagnosis and treatment. J Minim Invasive Gynecol. 2007: 481 [PMID: 17630167, https://doi.org/10.1016/j.jmig.2006.11.012]
2. Samal SK, Rathod S. Cervical ectopic pregnancy. J Nat Sci Biol Med. 2015: 257 [PMID: 25810679, https://doi.org/10.4103/0976-9668.149221]
3. Javedani Masroor M, Zarei A, Sheibani H. Conservative Management of Cervical Pregnancy with the Administration of Methotrexate and Potassium Chloride: A Case Report. Case Rep Obstet Gynecol. 2022: 1352868 [PMID: 36386423, https://doi.org/10.1155/2022/1352868]
4. Fouda A, Enayat A, Ahmed WE. Conservative management of a viable cervical ectopic pregnancy with systemic and multiple local methotrexate injections. A case report. Eur J Contracept Reprod Health Care. 2022: 265 [PMID: 35129019, https://doi.org/10.1080/13625187.2022.2026325]
5. Ghoubara ASM, Elsheikh JSA, Abdulwahab HR, Taha AAA. Intra-amniotic and systemic administration of methotrexate with concomitant surgical evacuation of 11 + 5 weeks cervical ectopic pregnancy: a case report. BMC Pregnancy Childbirth. 2023: 486 [PMID: 37393228, https://doi.org/10.1186/s12884-023-05794-0]
6. Hoyos LR, Tamakuwala S, Rambhatla A, Brar H, Vilchez G, Allsworth J, Rodriguez-Kovacs J, Awonuga A. Risk factors for cervical ectopic pregnancy. J Gynecol Obstet Hum Reprod. 2019: 101665 [PMID: 31811970, https://doi.org/10.1016/j.jogoh.2019.101665]
7. Rodríguez MC, de los Bueis Fernández J, Goikoetxea E, Celada IAM, Laínz L, Exposito A, Weinig RM. Risk factors for cervical ectopic pregnancy: Systematic review of the literature and comparision with a control group of women at labor. Progresos de obstetricia y ginecología: revista oficial de la Sociedad Española de Ginecología y Obstetricia. 2020: 60
8. Sharma A, Ojha R, Mondal S, Chattopadhyay S, Sengupta P. Cervical intramural pregnancy: Report of a rare case. Niger Med J. 2013: 271 [PMID: 24249957, https://doi.org/10.4103/0300-1652.119670]
9. Kirk E, Condous G, Haider Z, Syed A, Ojha K, Bourne T. The conservative management of cervical ectopic pregnancies. Ultrasound Obstet Gynecol. 2006: 430 [PMID: 16514619, https://doi.org/10.1002/uog.2693]
10. Tang L, Nie S, Ling L, Zhu Q. Predictors of treatment failure of tubal pregnancy with single-dose methotrexate regimen - a systematic review and meta-analysis. J Obstet Gynaecol. 2025: 2447997 [PMID: 39773144, https://doi.org/10.1080/01443615.2024.2447997]
11. Aiob A, Yousef H, Abu Shqara R, Mustafa Mikhail S, Odeh M, Lowenstein L. Risk factors and prediction of ectopic pregnancy rupture following methotrexate treatment: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2023: 181 [PMID: 37146508, https://doi.org/10.1016/j.ejogrb.2023.04.030]
12. Faschingbauer F, Mueller A, Voigt F, Beckmann MW, Goecke TW. Treatment of heterotopic cervical pregnancies. Fertil Steril. 2011: 1787 e9 [PMID: 21122844, https://doi.org/10.1016/j.fertnstert.2010.10.043]
13. Sanchez-Ferrer ML, Machado-Linde F, Pertegal-Ruiz M, Garcia-Sanchez F, Perez-Carrion A, Capel-Aleman A, Parilla-Paricio JJ, Abad-Martinez L. Fertility preservation in heterotopic cervical pregnancy: what is the best procedure? Fetal Diagn Ther. 2011: 229 [PMID: 21821998, https://doi.org/10.1159/000329307]
14. Mashiach S, Admon D, Oelsner G, Paz B, Achiron R, Zalel Y. Cervical Shirodkar cerclage may be the treatment modality of choice for cervical pregnancy. Hum Reprod. 2002: 493 [PMID: 11821302, https://doi.org/10.1093/humrep/17.2.493]
15. Singh S. Diagnosis and management of cervical ectopic pregnancy. J Hum Reprod Sci. 2013: 273 [PMID: 24672169, https://doi.org/10.4103/0974-1208.126312]
16. Jung SE, Byun JY, Lee JM, Choi BG, Hahn ST. Characteristic MR findings of cervical pregnancy. Journal of Magnetic Resonance Imaging. 2001: 918 https://doi.org/10.1002/jmri.1131]
17. Mullany K, Minneci M, Monjazeb R, O CC. Overview of ectopic pregnancy diagnosis, management, and innovation. Womens Health (Lond). 2023: 17455057231160349 [PMID: 36999281, https://doi.org/10.1177/17455057231160349]
18. Ding W, Zhang X, Qu P. An Efficient Conservative Treatment Option for Cervical Pregnancy: Transcatheter Intra-Arterial Methotrexate Infusion Combined with Uterine Artery Embolization Followed by Curettage. Med Sci Monit. 2019: 1558 [PMID: 30814484, https://doi.org/10.12659/MSM.913262]
19. Fowler ML, Wang D, Chia V, Handal-Orefice R, Latortue-Albino P, Mulekar S, White K, Perkins R. Management of Cervical Ectopic Pregnancies: A Scoping Review. Obstet Gynecol. 2021: 33 [PMID: 34259461, https://doi.org/10.1097/AOG.0000000000004423]
20. Annan JJK, Ansah-Asamoah S, Agyei BA, Quarshie EL, Ankobea F, Vanderpuye S, Oteng C, Ninimiya SY, Abaidoo NEA. Successful conservative management of a large 12-week-old cervical ectopic pregnancy in a nulliparous woman: a case report. Pan Afr Med J. 2023: 107 [PMID: 37719059, https://doi.org/10.11604/pamj.2023.45.107.35701]

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Bassant Farag Elshatby, Ahmed Marey, Hisham Hosney Elgammal, Hany Atef Bakr, Mohamed Hesham Gamal