Background: At less than 1% of all ectopic pregnancies, cervical ectopic pregnancy (CEP) is a very uncommon type of ectopic gestation. Due to the significant danger of major hemorrhage, which frequently requires a hysterectomy if left untreated, early detection is essential. Early identification and fertility-preserving treatment techniques have been made possible by advancements in transvaginal ultrasonography and serum beta-human chorionic gonadotropin (β-hCG) monitoring.

Case Presentation: We report the case of a 26-year-old gravida 2 para 1 live 1 woman with a prior lower segment cesarean section who presented with vaginal bleeding and a positive urine pregnancy test. Transvaginal ultrasonography revealed an empty uterine cavity with a gestational sac located within the cervical canal, consistent with cervical ectopic pregnancy. Her initial serum β-hCG level was 3034.14 mIU/mL. After counseling regarding medical and surgical options, the patient opted for conservative medical management. A multidose methotrexate regimen was administered, with serial monitoring of β-hCG levels demonstrating a progressive decline to non-pregnant levels within four weeks. The patient experienced no major complications. Notably, she conceived spontaneously six months later and is currently continuing a viable intrauterine pregnancy under regular antenatal surveillance.

Conclusion: In hemodynamically stable individuals, conservative medical care with multidose methotrexate can be a safe and successful fertility-preserving strategy. This case further emphasizes the significance of early detection of cervical ectopic pregnancy. Improved reproductive results and a considerable reduction in maternal morbidity are achieved with prompt detection and tailored care.

Keywords: Cervical ectopic pregnancy, methotrexate, conservative management, fertility preservation, β-hCG

1. Évora F, Hundarova K, Águas F, Carvalho G. Cervical Ectopic Pregnancy: A Multidisciplinary Approach. Cureus. 2021 Oct;13(10):e19113. doi:10.7759/cureus.19113 PubMed PMID: 34858755; PubMed Central PMCID: PMC8614163.
2. Samal SK, Rathod S. Cervical ectopic pregnancy. J Nat Sci Biol Med. 2015;6(1):257–60. doi:10.4103/0976-9668.149221 PubMed PMID: 25810679; PubMed Central PMCID: PMC4367055.
3. Nikolettos K, Oikonomou E, Kotanidou S, Kritsotaki N, Kyriakou D, Tsikouras P, et al. A Systematic Review about Cervical Pregnancy and our Experience. Acta Med Litu. 2024;31(1):92–101. doi:10.15388/Amed.2024.31.1.13 PubMed PMID: 38978851; PubMed Central PMCID: PMC11227684.
4. Szmygin M, Kłobuszewski B, Nieoczym K, Dymara-Konopka W, Woźniak S, Szmygin H, et al. Cervical Ectopic Pregnancies—Imaging and Endovascular Treatment. Diagnostics. 2025 Aug 4;15(15):1956. doi:10.3390/diagnostics15151956
5. Annan JJK, Ansah-Asamoah S, Agyei BA, Quarshie EL, Ankobea F, Vanderpuye S, et al. Successful conservative management of a large 12-week-old cervical ectopic pregnancy in a nulliparous woman: a case report. Pan Afr Med J. 2023;45:107. doi:10.11604/pamj.2023.45.107.35701 PubMed PMID: 37719059; PubMed Central PMCID: PMC10504439.
6. Stoyanova N, Yordanov A, Popovski N. Current Trends in the Treatment of Cervical Pregnancy: A Narrative Review. Medicina (Kaunas). 2025 Nov 20;61(11):2072. doi:10.3390/medicina61112072 PubMed PMID: 41303906; PubMed Central PMCID: PMC12654775.
7. Saab R, Melnyk M, Ferguson G, Pilgrim J. Cervical Ectopic Pregnancy After Frozen Embryo Transfer: Methotrexate Failure Managed With Uterine Artery Embolization and Ultrasound-Guided Curettage. Cureus. 2025 Dec;17(12):e98928. doi:10.7759/cureus.98928 PubMed PMID: 41523535; PubMed Central PMCID: PMC12788989.
8. Fouda A, Enayat A, Ahmed WE. Conservative management of a viable cervical ectopic pregnancy with systemic and multiple local methotrexate injections. A case report. Eur J Contracept Reprod Health Care. 2022 Jun;27(3):265–8. doi:10.1080/13625187.2022.2026325 PubMed PMID: 35129019.
9. Ding W, Zhang X, Qu P. An Efficient Conservative Treatment Option for Cervical Pregnancy: Transcatheter Intra-Arterial Methotrexate Infusion Combined with Uterine Artery Embolization Followed by Curettage. Med Sci Monit. 2019 Feb 28;25:1558–65. doi:10.12659/MSM.913262 PubMed PMID: 30814484; PubMed Central PMCID: PMC6404629.
10. Timor-Tritsch IE, Monteagudo A, Mandeville EO, Peisner DB, Anaya GP, Pirrone EC. Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography. Am J Obstet Gynecol. 1994 Mar;170(3):737–9. doi:10.1016/s0002-9378(94)70273-x PubMed PMID: 8141192.
11. Murji A, Garbedian K, Thomas J, Cruickshank B. Conservative Management of Cervical Ectopic Pregnancy. J Obstet Gynaecol Can. 2015 Nov;37(11):1016–20. doi:10.1016/s1701-2163(16)30051-2 PubMed PMID: 26629722.
12. Ramanathan R, Rajan N. A successful conservative management of cervical ectopic pregnancy. Int J Reprod Contracept Obstet Gynecol. 2024 May 29;13(6):1609–11. doi:10.18203/2320-1770.ijrcog20241459
13. Gaillard F, Knipe H, Al-Saig A. Ectopic pregnancy. In: Radiopaedia.org [Internet]. Radiopaedia.org; 2008 [cited 2026 Feb 23]. Available from: https://radiopaedia.org/articles/1258 doi:10.53347/rID-1258

Dr Ananya Patel S.G

Junior Resident, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore