Interstitial Pregnancy Managed with Single-dose Systemic Methotrexate: A Case Report (original) (raw)
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Interstitial pregnancy treated with a single-dose of systemic methotrexate: A successful management
2015
Interstitial pregnancy is an ectopic pregnancy at high hemorrhagic risk. It often poses a diagnostic and therapeutic challenge to the clinician, with a significant risk of morbidity and mortality. It presents a difficult management problem with no absolute standard of care; the most appropriate treatment technique for these pregnancies remains controversial. We describe a case of unruptured interstitial pregnancy successfully treated with a single-dose of systemic methotrexate with subsequent ultrasound and serum beta human chorionic gonadotropin monitoring. Medical management can be a safe and successful option in selected cases that satisfy specific criteria and in women who are able to be monitored after treatment.
Interstitial Ectopic Pregnancy—Case Reports and Medical Management
Medicina
The term intramural (interstitial) ectopic pregnancy refers to a pregnancy developing outside the uterine cavity, with a gestational sac implanted into the interstitial part of the Fallopian tube, surrounded by a layer of the myometrium. The prevalence rate of interstitial pregnancy (IP) is 2–4% of all ectopic pregnancies. Surgery is the primary treatment for interstitial ectopic pregnancy; the pharmacological management of ectopic pregnancy, including IP, in asymptomatic patients includes systemic administration of methotrexate. In this report, we present two cases of this rare pregnancy type, reviewing our management technique and treatment ways presented in the literature. In our patients, the management was initially conservative and included methotrexate, administered as intravenous bolus injection, regular beta-human chorionic gonadotropins (β-HCG) level measurements in peripheral blood, and monitoring of the patient’s general condition. Due to signs of intra-abdominal bleedin...
Interstitial Pregnancy: From Medical to Surgical Approach—Report of Three Cases
Case Reports in Obstetrics and Gynecology, 2018
Background.Interstitial pregnancy is a rare form of ectopic pregnancy that usually leads to uterine rupture resulting in sudden life-threatening haemorrhage, need for blood transfusion, and admission to intensive care unit. Mortality rate is 6–7 times higher than that in classical ectopic pregnancy. Uterine rupture has been typically reported to occur at more advanced gestational ages compared to tubal pregnancy although several recent reports have shown a high risk of rupture before 12 weeks of gestation.Cases Presentation.We report three cases of women affected by interstitial pregnancy, with different clinical symptoms, and managed to be treated with surgery or medical therapy. An emergency laparotomy was performed in the first case by the general surgeon, while in the second case laparoscopy was made by a gynecologist; last case shows the success of systemic administration of methotrexate.Conclusion.Interstitial pregnancy is still a challenging condition to diagnose and treat; e...
BioMed Research International
Introduction. Interstitial pregnancy (IP) is an ectopic pregnancy (EP) located in the portion of the fallopian tube that penetrates the uterine muscular layer. Incidence increased in the last two decades with the widespread use of the assisted reproductive techniques. It is estimated in 1-6% of all the EPs, with a maternal mortality rate of 2.0-2.5%. Clinical presentation, gestational age at diagnosis, beta-human chorionic gonadotropin (β-hCG) levels, ultrasound features, and patient preference, should be considered to determine the best management: surgical, medical treatment, or close observation. We report two cases of IP successfully managed with systemic MTX and Mifepristone: in one case β-hCG was >10.000 mIU/mL and a vital embryo was present. Materials and Methods. A literature search was carried out on MEDLINE, EMBASE, and PUBMED. We identified two cases of IP referred to the Institute for Maternal and Child Burlo Garofolo, Trieste. Data related to clinical presentation, β...
Obstetrics and gynecology international, 2009
Background. The upper anterior abdominal wall is a very unusual location for an ectopic pregnancy making optimal management uncertain. Case. We report the case of a 26-year-old gravida 4, para 1, aborta 2 with a rising quantitative human chorionic gonadotropin level following a negative diagnostic laparoscopic examination. She was subsequently diagnosed with an abdominal wall ectopic pregnancy 2 cm inferior to the liver. A single percutaneous intralesional injection of methotrexate was successful after initial failure with systemic methotrexate. Conclusion. Systemic methotrexate is a logical first choice for management of a stable early abdominal wall pregnancy. Direct intralesional injection of methotrexate as the next treatment choice may avoid the morbidity linked with operative management.
A case report on ruptured interstitial ectopic pregnancy: diagnostic dilemma
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019
The ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Interstitial ectopic pregnancies are gestations that implant within the proximal, intramural portion of the fallopian tubes with high vascularity. Ectopic pregnancy in the interstitial part of the fallopian tubes can be life-threatening considering the thin myometrial tissue surrounding the gestational sac and high vascularization which may result in catastrophic haemorrhage when interstitium is ruptured. Being a hazardous type of ectopic pregnancy, it becomes extremely important to diagnose and manage it. This condition presents a challenge for clinical as well as radiological diagnosis. Generally, a case of interstitial ectopic pregnancy has typical radiological features distinguishing it from other ectopic. The ultrasonographic finding of interstitial line has better sensitivity (80%) and specificity (98%) than eccentric gestational sac location...
Conservative medical and surgical management of interstitial ectopic pregnancy
Fertility and Sterility, 1999
Objective: To review the definition and diagnosis of interstitial and heterotopic interstitial pregnancy and to evaluate the conservative management of these conditions. Design: A MEDLINE computer search was used to identify relevant studies. The mean values for the duration of amenorrhea, serum -hCG level, size of the ectopic mass, and success rates of the various treatment modalities were calculated from the raw data in the original publications.
Case report of a Successful Treatment of Interstitial Pregnancy with Systemic Methotrexate
Abant Medical Journal
Ektopik gebelik ilk trimesterde morbidite ve mortalitenin en sık nedenidir. İnterstisyal gebelik ektopik gebeliğin en nadir formlarından olup tüm ektopik gebeliklerin %2-4'ünü oluşturmaktadır. Bu yazımızda girişime gerek kalmadan sistemik Metotreksat ile başarılı şekilde tedavi edilmiş interstisyal gebelik olgusunu tartıştık. Seri β-hCG ölçümlerinde yeterli regresyon izlendi ve operasyona ihtiyaç kalmadı. Klinik deneyimimize göre hemodinamik olarak stabil, batında ve pelviste ağrısı olmayan interstisyal gebeliği olan hastalarda sistemik MTX tedavisi seri β-hCG ölçümleri ile izlem yapılarak uygulanması cerrahiye gereksinimi azaltmakta ve de böylece morbidite ve mortaliteye de olumlu yönde katkıda bulunmaktadır.