Methotrexate in Interstitial Pregnancy: A Miraculous Fertility Rescuer.

Abstract

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 resection/hysterectomy used to be the traditional treatment for these cases. However conservative management has been increasingly practiced successfully including medical treatment with systemic methotrexate and laparoscopic conservative surgery.