Multidosing Intramuscular Administration of Methotrexate in Interstitial Pregnancy With Very High Levels of β-hCG: A Case Report and Review of the Literature (original) (raw)
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International Journal of Environmental Research and Public Health
Interstitial pregnancy (IP) accounts for 2% of all ectopic pregnancies and has a mortality rate of 2–2.5%. The diagnosis is made by a transvaginal ultrasound and the treatment can be medical or surgical. We report the case of a 36-year-old primigravida who was 6 + 5 weeks pregnant, diagnosed with interstitial pregnancy by ultrasound, who had a very high serum β-hCG level (31,298 mIU/mL) and wanted to preserve her fertility. The patient was treated with one dose of mifepristone and a double dose of methotrexate since the decrease in the β-hCG serum level was less than 15% after the first dose. At the beginning, medical therapy was effective, as no embryonal cardiac activity was detected and serum β-hCG levels decreased early, but on the 20th day of hospitalization, the patient underwent surgery for her clinical symptoms and the evidence of free fluid in the Douglas pouch at a transvaginal ultrasound exam. Our experience showed that medical treatment should be considered, especially i...
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.
Methotrexate in Interstitial Pregnancy: A Miraculous Fertility Rescuer
International Journal of Contemporary Medical Research [IJCMR], 2019
Introduction: Interstitial (cornual) gestation is the most hazardous type of ectopic, where pregnancy gets implanted in the proximal portion of tube that traverses myometrium . It constitutes 2-4% of all ectopic pregnancies.It poses a significant diagnostic and therapeutic challenge and carries a greater maternal mortality. It usually presents at a later gestation more than 7-12 weeks .The usual clinical presentation is profuse intraabdominal bleeding and shock. Transvaginal sonography can be helpful, but often is not conclusive. Case report: 21 year old nulliparous lady post laparascopic left salpingo-oopherectomy, diagnosed to have a live interstitial ectopic pregnancy in left lateral wall of uterus with very high levels of βhCG . She was treated with 2 cycles of folinic acid rescue regime and βhCG monitored accordingly. βhCG showed a decline of 15% initially (2365.9mIU/ml) and weekly βhCG monitored thereafter and reduced to 3.39mIU/ ml within 4 months. Conclusion: Cornual resecti...
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 pregnancies' diagnosis and management: an eleven cases series
Swiss Medical Weekly, 2013
PRINCIPLES: Interstitial pregnancy represents 2% of ectopic pregnancies, but it is a highly morbid condition with a 2.5% of maternal mortality. Its diagnostic and therapeutic management remains controversial. The aim of this review is to describe the management of interstitial pregnancy in our institution between 2001 and 2011 and to define some general rules for the clinical practice. METHODS: Single institution retrospective study. RESULTS: Eleven women were treated for interstitial pregnancy. The median age was 33 years and the median gestity was 4. Seven patients had a history of gynaecological surgery and four interstitial pregnancies followed in vitro fertilisation. The diagnosis was made at a median gestational age of seven weeks with a median beta-HCG level of 5,838 U/l. Six of the eleven patients received an initial treatment with intracornual methotrexate, three with intramuscular methotrexate and two with surgery. The median time to beta-HCG resolution was 58 days. Three of the eleven patients needed a second line treatment: two after intramuscular methotrexate and one after intracornual methotrexate. Six patients had further pregnancies and delivered by caesarean section. CONCLUSIONS: A high prevalence of previous ectopic pregnancies, gynaecological surgery and of pregnancies resulting from in vitro fertilisation was observed. The earliness of the diagnosis was the factor that allowed a conservative treatment in most cases. Beta-HCG level follow up was fundamental in allowing a second line therapy but beta-HCG can persist over a long period of time and this must be taken into account due to its possible psychological impact. Intracornual methotrexate seems to be more efficacious than intramuscular methotrexate in our series.
Factors influencing the success of conservative treatment of interstitial pregnancy
Ultrasound in Obstetrics and Gynecology, 2005
Objective To identify demographic, morphological and biochemical characteristics of interstitial pregnancies that are associated with a successful outcome of conservative treatment (expectant management or medical treatment with methotrexate). Methods Over a period of 6 years all clinically stable women with a certain ultrasound diagnosis of interstitial ectopic pregnancy were managed either expectantly (no interventions) or medically (systemic or local methotrexate injection). The outcome of conservative treatment was compared to a number of diagnostic parameters, which were recorded at the initial visit. The treatment was classified as successful if serum human chorionic gonadotropin (hCG) level declined below 20 IU/L without the need for any additional interventions, such as the administration of methotrexate or surgery. Results A total of 42 interstitial pregnancies were diagnosed during the study period. Out of 35 women included in the final analysis 7 (20%) were managed expectantly and 28 (80%) received either local (n = 23) or systemic methotrexate (n = 5). There were no significant differences in the success rates of expectant treatment and treatment with either systemic or local methotrexate. The initial median serum hCG was significantly lower in women with successful conservative management (3216 IU/L vs. 15 900 IU/L; P < 0.05) but there were no other significant differences between cases with successful and failed treatment. Conclusion The measurement of serum hCG at the initial visit may be used to predict the likelihood of successful conservative treatment of interstitial pregnancy.
Three Conservative Approaches to Treatment of Interstitial Pregnancy
The Journal of the American Association of Gynecologic Laparoscopists, 2001
Interstitial pregnancy is among the most dangerous types of ectopic pregnancy. Four such pregnancies in three women were treated by three conservative modalities with favorable results. A 10-week interstitial pregnancy was successfully treated by laparoscopic-guided local methotrexate (MTX) injection into the gestational sac. Six years later the same woman had a repeat unruptured interstitial pregnancy at 9 weeks' gestation, with the gestational sac located in the same location as the previous one. Laparoscopic cornuostomy was performed. An asymptomatic woman in the eighth week of an interstitial pregnancy was treated with systemic MTX, but despite decreasing β-human chorionic gonadotropin levels, cornual rupture occurred. The patient was successfully treated by laparoscopic cornuostomy. The final patient was admitted in hypovolemic shock and hemoperitoneum and was treated successfully for ruptured 8-week interstitial pregnancy by laparoscopic cornuostomy.
International Journal of Women's Health
Objective: To study factors associated with the success of single dose methotrexate (MTX) treatment in women with ectopic pregnancy. Methods: This is a retrospective study of women (n=110) with ectopic pregnancy and treated with single dose of MTX. The clinical presentations, transvaginal sonography (TVS) findings, pretreatment beta-human chorionic gonadotropin (β-HCG), and progesterone values were compared between the treatment success (Group S) and treatment failure (Group F) groups. Results: The overall success rate of treatment with single dose of MTX was 75.45%. The majority of patients in both groups presented with pain and bleeding (~55%), and bleeding only was the presenting symptom in about 20% of patients. Only 3 patients (3.61%) in Group S required a repeat dose of MTX. In contrast, 51.8% of the Group F patients required a repeat dose. The mean pretreatment β-HCG level was 2.3 times higher in Group F than in Group S (1734±1684 vs 4036±2940 IU/L). The data showed a β-HCG level of 3924IU/L as a suitable cutoff value with 76.19% sensitivity and 62.5% specificity to predict MTX treatment success. History of ectopic pregnancy had no relation with success/treatment failure or a repeat dose. None of the TVS findings were related to the outcome of the treatment, whereas pretreatment HCG level was a significant predictor. Conclusion: The single dose MTX treatment was successful in 75.45% (83/110) of cases, with 3.61% (3/83) requiring a repeat dose of the drug. Pretreatment β-HCG level is a significant predictor of the treatment outcome.
Interstitial Pregnancy Managed with Single-dose Systemic Methotrexate: A Case Report
Journal of Nepal Medical Association, 2021
Interstitial pregnancy is a rare type of ectopic pregnancy with a high risk of massive hemorrhage on rupture as compared to ectopic on other sites. The mortality rate for the ruptured interstitial pregnancy is high. Therefore, early diagnosis of such pregnancy before the rupture occurs facilitates appropriate management and avoids life-threatening complications. With the advancement in diagnostic imaging modalities, early diagnosis and more conservative management for interstitial pregnancy have become possible. Here, we report a case of primigravida diagnosed with interstitial pregnancy with ultrasonography and successfully managed with a single dose of methotrexate.