Management of Cervical Ectopic Pregnancy: A Case Report from Cali, Colombia
Enrique HC1*; Jessica SS2; Luisa MND3; Juan MTP3
¹Department of Gynecology and Obstetrics, Coordinator of the Endocrinology and Infertility Area, , Universidad del Valle, and Reproductive Medicine Unit, Clínica Imbanaco.
²Specialist in Reproduction and Gynecological Endocrinology, Reproductive Medicine Unit, Imbanaco Clinic.
³Fellow in Reproductive Medicine, Clínica Imbanaco, Universidad del Valle.
*Corresponding author
Enrique HC, Department of Gynecology and Obstetrics, Coordinator of the Endocrinology and Infertility Area, , Universidad del Valle, and Reproductive Medicine Unit, Clínica Imbanaco.
DOI: 10.55920/JCRMHS.2025.11.001480
Figure 1: An embryo with positive cardiac activity is observed in the cervical canal
Figure 2: Verification of the operation of the Cook probe balloons
Figure 3: The Cook Balloon is observed in the cervical canal
Table 1: BHCG level monitoring
Liver function tests (AST 25 IU/L, ALT 30 IU/L), and renal function tests (creatinine 0.75 mg/dL) were performed prior to treatment with MTX (Disodium Methotrexate, Alfarma, Czech Republic, INVIMA 2007M-0006795) at a dose of 1 mg/kg. Considering the patient's BHCG levels (greater than 10,000 mIU/ml), it was decided to administer an interdaily MTX protocol with intramuscular administration on days 1, 3, 5, and 7, alternating with folinic acid at a dose of 0.1 mg/kg intramuscularly on even-numbered days.
The BHCG level 48 hours after MTX administration was 38,000 mIU/ml, and at 96 hours, it was 54,213 mIU/ml.
An ultrasound examination revealed an elongated gestational sac implanted in the endocervical canal, measuring 49x8x12 mm, with multiple mixed echocardiographic images consistent with hematomas, and an 11 mm embryo with cardiac activity. Complementary treatment was performed with an ultrasound-guided double-balloon catheter (Cook). 30 cc of distilled water was instilled into both airways to verify proper function (Image 2).
Under abdominal ultrasound guidance, 30 mg of MTX were administered vaginally with ultrasound-guided puncture at the saccular level and dilation of the internal cervical os (IO) was performed with a hysterometer and Hegar dilators (#2-4) without achieving passage to the uterine cavity in order to place the Cook double-balloon catheter., presenting profuse bleeding of approximately 500 cc, for which the cervical canal was explored obtaining a moderate amount of remains which were sent to pathology study; Cook catheter was placed at the level of the cervical canal and insufflated with 40 cc of distilled water, under ultrasound vision, reducing bleeding by 95%. The catheter was fixed at the hypogastrium level in order to avoid traction with movements of the lower limbs (See image 3).
In addition, a urinary catheter was left in place to monitor diuresis, given the profuse bleeding. Prophylactic antibiotics were used and a complete blood count and PCR were taken every 24 hours during the first 4 days, with quantitative BHCG monitoring and ultrasound follow-up.
The patient's progress was satisfactory, with minimal vaginal bleeding and decreased BHCG levels (see Table 1). A Doppler ultrasound was performed 3 days after Cook tube insertion. There was no evidence of ovulation remnants or color Doppler enhancement, so the Cook tube was removed. The patient was observed for 24 hours and discharged with instructions for BHCG monitoring and a Doppler ultrasound in 5 days. Family planning recommendations were received until the results of the genetic study of the pathology were known, in order to determine genetic and reproductive counseling.