{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T03:32:19Z","timestamp":1768447939329,"version":"3.49.0"},"reference-count":22,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>This report describes a catastrophic bleeding following methotrexate treatment of cervical pregnancy and dramatic response to Bakri surgical obstetric silicone (SOS) balloon tamponade in controlling massive bleeding. A 42-year-old woman was diagnosed for cervical pregnancy with a viable fetus at 12 weeks by transvaginal ultrasound. Conservative treatment with intrafetal potassium chloride injection and systemic methotrexate were instituted. On the sixth day of therapy, catastrophic bleeding lead to hypovolemic shock. After resuscitation and blood transfusion, we attempt to control the bleeding with evacuation and curettage but was unsuccessful. Bakri SOS balloon tamponade was applied with immediate and effective response. Nevertheless, total abdominal hysterectomy was performed. In conclusion, conservative treatment of cervical pregnancy with systemic methotrexate could be catastrophic in some patients. Control of active bleeding with Bakri SOS balloon tamponade may possibly be helpful in case of uncontrolled bleeding in selected cases.<\/jats:p>","DOI":"10.1136\/bcr-2013-200440","type":"journal-article","created":{"date-parts":[[2013,8,8]],"date-time":"2013-08-08T16:21:12Z","timestamp":1375978872000},"page":"bcr2013200440","source":"Crossref","is-referenced-by-count":8,"title":["Cervical pregnancy with massive bleeding after treatment with methotrexate"],"prefix":"10.1136","volume":"2013","author":[{"given":"Ubol","family":"Saeng-anan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Opas","family":"Sreshthaputra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kornkanok","family":"Sukpan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theera","family":"Tongsong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,8,8]]},"reference":[{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.1","first-page":"2005","article-title":"Cervical ectopic pregnancy successfully treated with local methotrexate injection","volume":"2013","author":"Cerveira","year":"2008","journal-title":"Fertil Steril"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.2","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1002\/uog.2693","article-title":"The conservative management of cervical ectopic pregnancies","volume":"2013","author":"Kirk","year":"2006","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.3","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S1701-2163(16)35217-3","article-title":"Multidose methotrexate treatment of cervical pregnancy","volume":"2013","author":"Weibel","year":"2012","journal-title":"J Obstet Gynaecol Can"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.4","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1159\/000329307","article-title":"Fertility preservation in heterotopic cervical pregnancy: what is the best procedure?","volume":"2013","author":"Sanchez-Ferrer","year":"2011","journal-title":"Fetal Diagn Ther"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.5","first-page":"2123","article-title":"Cervical pregnancy","volume":"2013","author":"Bianchi","year":"2011","journal-title":"Fertil Steril"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.6","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1002\/uog.6363","article-title":"Conservative management of spontaneous heterotopic cervical pregnancy using an aspiration cannula and pediatric Foley catheter","volume":"2013","author":"Kim","year":"2009","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.7","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/S1028-4559(09)60015-2","article-title":"Cervical pregnancy treated with systemic methotrexate administration and resectoscopy","volume":"2013","author":"Lin","year":"2008","journal-title":"Taiwan J Obstet Gynecol"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.8","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1080\/13625180802254571","article-title":"Cervical pregnancy: a case series and a review of current clinical practice","volume":"2013","author":"Cipullo","year":"2008","journal-title":"Eur J Contracept Reprod Health Care"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.9","first-page":"950","article-title":"Successful management of cervical pregnancy with medical intervention only: a case report","volume":"2013","author":"Emmi","year":"2007","journal-title":"J Reprod Med"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.10","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/00006254-199701000-00023","article-title":"Cervical pregnancy: past and future","volume":"2013","author":"Ushakov","year":"1997","journal-title":"Obstet Gynecol Surv"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.11","doi-asserted-by":"crossref","first-page":"959","DOI":"10.7863\/jum.2007.26.7.959","article-title":"Successful management of a consecutive cervical pregnancy by sonographically guided transvaginal local injection: case report and review of the literature","volume":"2013","author":"Ferrara","year":"2007","journal-title":"J Ultrasound Med"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.12","first-page":"31","article-title":"An efficient conservative treatment modality for cervical pregnancy: angiographic uterine artery embolization followed by immediate curettage","volume":"2013","author":"Wang","year":"2011","journal-title":"Am J Obstet Gynecol"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.13","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s00404-003-0567-9","article-title":"Cervical pregnancy treated with transvaginal ultrasound-guided intra-amniotic instillation of methotrexate","volume":"2013","author":"Hassiakos","year":"2005","journal-title":"Arch Gynecol Obstet"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.14","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1080\/00016340500500444","article-title":"Successful conservative treatment of a 14-week gestational age cervical pregnancy by primary local injection of single-dose intra-amniotic methotrexate and intracardiac potassium chloride feticide","volume":"2013","author":"Jeng","year":"2006","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.15","first-page":"386","article-title":"[Treatment of cervical pregnancy with systemic methotrexate and KCI solution injection into the gestational sac\u2014case report and review of literature]","volume":"2013","author":"Polak","year":"2011","journal-title":"Ginekol Pol"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.16","first-page":"2722","article-title":"[Cervical pregnancy can be managed conservatively with methotrexate]","volume":"2013","author":"Sorensen","year":"2011","journal-title":"Ugeskr Laeger"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.17","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/0301-2115(96)02500-6","article-title":"Combined systemic and intra-amniotic treatment of cervical pregnancy by methotrexate. A report of two cases","volume":"2013","author":"Kaminopetros","year":"1996","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.18","doi-asserted-by":"crossref","first-page":"359","DOI":"10.7863\/jum.2004.23.3.359","article-title":"Sonographically guided minimally invasive treatment of unusual ectopic pregnancies","volume":"2013","author":"Doubilet","year":"2004","journal-title":"J Ultrasound Med"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.19","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1016\/S0002-9378(99)70389-3","article-title":"Efficacy of methotrexate treatment in viable and nonviable cervical pregnancies","volume":"2013","author":"Kung","year":"1999","journal-title":"Am J Obstet Gynecol"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.20","first-page":"827","article-title":"Conservative management of cervical pregnancy. A case-report","volume":"2013","author":"Ben","year":"2008","journal-title":"Tunis Med"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.21","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1186\/1752-1947-4-212","article-title":"Modification of conservative treatment of heterotopic cervical pregnancy by Foley catheter balloon fixation with cerclage sutures at the level of the external cervical os: a case report","volume":"2013","author":"Hafner","year":"2010","journal-title":"J Med Case Rep"},{"key":"2025042709014106000_2013.aug08_2.bcr2013200440.22","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1097\/01.AOG.0000262052.09350.52","article-title":"Transvaginal ultrasound-guided treatment of cervical pregnancy","volume":"2013","author":"Jeng","year":"2007","journal-title":"Obstet Gynecol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2013-200440","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T16:01:50Z","timestamp":1745769710000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2013-200440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,8,8]]},"references-count":22,"alternative-id":["10.1136\/bcr-2013-200440"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2013-200440","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,8,8]]}}}