Cervical ectopic pregnancy: Persistence despite a serologically negative β-hCG: A case report

BACKGROUND: Cervical pregnancy is a rare type of ectopic pregnancy that can be associated with significant hemorrhage and loss of fertility. Given its rarity, most effective treatment protocols are not well established. CASE: A 33-year-old primigravid woman at 11 weeks’ gestation presented to our institution with a cervical ectopic pregnancy with an initial β-hCG of 114,080 IU/L. She received 2 doses of systemic multidose methotrexate (1 mg/kg) with oral leucovorin on alternating days. Fetal intracardiac potassium chloride injection was also performed. Despite an appropriate decline to undetectable levels of serum β-hCG, as well as resumption of menses, there was persistent sonographic demonstration of the cervical ectopic pregnancy. Surgery was ultimately required to remove the ectopic products of conception. CONCLUSION: Despite seemingly successful medical treatment of the cervical ectopic pregnancy with resultant undetectable serum β-hCG levels, surgery was necessary for complete resolution of the cervical pregnancy. This report supports the need to integrate both serum β-hCG levels and ultrasound to ensure complete resolution of these rare pregnancies.