Background Cervical pregnancy is a rare form of ectopic pregnancy in which the embryo implants within the cervical canal. With the growing use of assisted reproductive technologies (ARTs), its incidence has gradually increased. Traditionally, management often necessitated hysterectomy due to the high risk of severe hemorrhage. However, conservative approaches using methotrexate (MTX), either alone or in combination with adjunctive therapies, have demonstrated success in preserving fertility. Case presentation We present the case of a 38-year-old woman who presented with amenorrhea and prolonged vaginal bleeding. Ultrasonography and elevated serum beta-human chorionic gonadotropin (β-hCG) levels confirmed the diagnosis of cervical pregnancy. The patient was treated with systemic MTX (50 mg/m 2 ) in combination with a traditional Chinese medicine (TCM) formula designed to promote blood circulation and resolve stasis. During the treatment, she experienced transient heavy vaginal bleeding that required transfusion but did not necessitate surgical intervention. β-hCG levels declined progressively, ultrasonography confirmed complete resolution of the gestational sac, and menstruation resumed 18 days after treatment completion. Conclusion Combined therapy with MTX and TCM may provide an effective, fertility-preserving option for carefully selected patients with cervical pregnancy. TCM may enhance the efficacy of MTX, facilitate tissue resorption, and reduce drug toxicity. Further research is warranted to standardize herbal dosages and clarify the underlying pharmacological mechanisms.
Zhang et al. (Fri,) studied this question.