Intérêt du méthotrexate dans la prise en charge des grossesses cervicales

Cervical pregnancy is one of the rarest location of ectopic pregnancies. During uterine evacuation major complications include important hemorrhage potentially affecting the patient's vital prognosis. Treatment by methotrexate (MTX) represents an interesting alternative to surgery. We report the case of a 30-year-old patient consulting for vaginal bleeding at eight weeks of amenorrhea and with a personal history of four curettages and one caesarean section. Clinical examination showed a congestive and enlarged cervix without other abnormalities, the level of ß HCG was 38,652 MIU/mL. Ultrasound showed an empty uterine cavity and the presence of a gestational bag containing an embryo with cardiac activity in cervical location. The patient received a single dose of MTX at a rate of 1 mg/kg. However ßHCG continued to raise at day 4 and 7 after treatment. The treatment was repeated with a multi-dose of MTX during five days resulting in a favorable evolution. The case is discussed with a review of the literature.