PMC8598359_01
Cervical pregnancy at presentation (a) 2D transvaginal sonography in sagittal view shows an empty uterine cavity and closed internal os with ballooned cervical canal containing gestational tissue with (b) evidence of peritrophoblastic vascularity.
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Transvaginal ultrasound showed an empty uterine cavity with thick endometrial lining and a ballooned cervical canal with a gestational sac containing a yolk sac in the lower portion of the cervix and an absent "sliding sign" (Figure 1(a)). The use of Color Doppler studies showed extensive blood flow to the gestational sac (Figure 1(b)).
Transabdominal puncture using a 17-gauge needle under transvaginal ultrasound guidance. Aspiration of (a, b) gestational content followed by (c, d) local methotrexate administration.
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Under general anesthesia, a local 75 mg dose of methotrexate was injected into the gestational sac using a 17-gauge needle (Chiba Needle, Cook Medical) under transvaginal ultrasound guidance with a prior aspiration of the gestational sac's fluid content to reduce pregnancy volume (Figure 2).
(a, b) 16 days posttreatment, beta-hCG levels 3.689 mIU/mL, (c) 28 days posttreatment, beta-hCG levels 305.7 mIU/mL, and (d) 31 days posttreatment, beta-hCG levels 86.4 mIU/mL.
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During four weeks of follow-up (EPU), the patient remained asymptomatic and serum beta-hCG levels decreased steadily from 3.689 mIU/mL on day 16 (Figures 3(a) and 3(b)) to 4 mIU/mL on day 46. Transvaginal ultrasound findings were suggestive of gestational sac regression (Figure 3).