Heterotopic pregnancy: successful management with aspiration of cornual/interstitial gestational sac and instillation of small dose of methotrexate.
OBJECTIVE
Terminating a corneal pregnancy without jeopardizing a coexistent intrauterine pregnancy.


METHODS
A 29-year-old woman with a 4-year history of primary infertility became pregnant after in-vitro fertilization and embryo transfer. A heterotopic pregnancy with a left cornual and intrauterine sacs was confirmed by early transvaginal scan examinations. The ectopic sac was aspirated under ultrasound guidance followed by local injection of 12.5 mg methotrexate. This was followed by serial ultrasound scans and serum betahCG assays.


RESULTS
The fetal pole in the ectopic pregnancy disappeared following the procedure. She had no significant vaginal bleeding or any other unusual symptoms. The intrauterine pregnancy progressed satisfactorily until spontaneous onset of labour and vacuum extraction delivery at 39 weeks. The baby weighed 2.9 kg.


CONCLUSIONS
Local injection of low-dose methotrexate following aspiration of a cornual pregnancy proved effective in halting the ectopic trophoblasts' growth without adversely affecting a coexistent intrauterine pregnancy. The injected ectopic trophoblasts resolved quickly despite the small dose of methotrexate used. This technique avoided a more costly surgical treatment with its associated risks in subsequent pregnancies.
Oyawoye
Seye
S
Department of Obstetrics and Gynaecology, Royal Free Campus, Royal Free and University College Medical School, London, UK.
Chander
Bina
B
Pavlovic
Biserka
B
Hunter
Jocelyn
J
Gadir
Ahmed Abdel
AA
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013396:Suction; D014463:Ultrasonography
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate