ARE SERUM HUMAN CHORIONIC-GONADOTROPIN CLEARANCE CURVES OF USE IN MONITORING METHOTREXATE TREATMENT IN CERVICAL PREGNANCY

Objective: To describe the monitoring of an unsuccessful case of metho trexate treatment of cervical pregnancy. Design: Case report. Setting: University hospital. Patient(s): A 27-year-old woman, gravida 3, para 1, with a vital cervical pregnancy. Intervention(s): Feticide and met hotrexate administered both locally and systemically. Main Outcome Mea sure(s): Treatment success, defined as elimination of the cervical pre gnancy with preservation of the uterus. Result(s): Despite reassuringl y declining serum hCG concentrations, several episodes of severe vagin al bleeding demanded transfusions of 19 U of packed cells, two angiogr aphic embolizations that were complicated by septicemia, and a balloon catheter tamponade followed by a third angiographic embolization. Ult imately, a hysterectomy was necessary because of uncontrollable vagina l bleeding. Conclusion(s): This case report shows that serum hCG monit oring was not helpful in the detection of impending treatment failure. Currently, no guidelines are available to clinicians for predicting t reatment failure of methotrexate in patients with cervical pregnancy. Serum hCG clearance curves do enable the timely detection of inadequat ely declining serum hCG concentrations, for which additional methotrex ate can be administered. (Fertil Steril(R) 1998;70:362-5. (C) 1998 by American Society for Reproductive Medicine.).