title: Successful treatment of advanced interstitial pregnancy with methotrexate and hysteroscopy. A case report.
abstract: BACKGROUND
  Data concerning medical treatment of interstitial ectopic pregnancies are scarce. These pregnancies are characterized by late and serious clinical manifestations. We report a case of advanced interstitial pregnancy treated successfully by combining methotrexate (MTX) and hysteroscopy.
  
  
  METHODS
  A routine ultrasonic evaluation of a 10-week pregnancy revealed a right interstitial gestational sac 58 mm in diameter and containing an embryo with a crownrump length of 29 mm and embryonic heartbeats. Serum beta-human chorionic gonadatropin (hCG) level was 97,950 mIU/mL. The patient was treated with a systemic MTX/leucovorin regimen. At the end of the one-week course, no embryonic cardiac activity was detected, and a decrease in beta-hCG levels commenced. Persistent trophoblastic tissue, manifested by a low (26 mIU/mL) beta-hCG level in plateau, was successfully removed by way of hysteroscopy.
  
  
  CONCLUSIONS
  Early detection of interstitial pregnancy may facilitate conservative medical treatment.
authors.affiliation: Department of Obstetrics and Gynecology, LisSerlin Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Groutz
authors.forename: Y
authors.initials: Y
authors.lastname: Wolf
authors.forename: B
authors.initials: B
authors.lastname: Caspi
authors.forename: I
authors.initials: I
authors.lastname: Wolman
authors.forename: D
authors.initials: D
authors.lastname: Gordon
authors.forename: M P
authors.initials: MP
authors.lastname: David
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000328:Adult; D000931:Antidotes / Q000627:therapeutic use; D004724:Endoscopy; D005187:Fallopian Tubes / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D002955:Leucovorin / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000628:therapy*; D014463:Ultrasonography; D014599:Uterus / Q000473:pathology / Q000601:surgery
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000931:Antidotes; D002955:Leucovorin; D008727:Methotrexate