Successful rescue of an early interstitial pregnancy after failed systemic methotrexate treatment: a case report.
BACKGROUND
Interstitial (cornual) pregnancy is a rare and life-threatening disease. Although systemic treatment with methotrexate (MTX) in an unruptured interstitial pregnancy has been used to preserve the entirety of the uterus, surgery is often used as a rescue method in failed cases. Use of an ultrasound-guided local injection can be a good alternative to surgery.


METHODS
A 30-year-old woman, gravida 1, para 0, with an interstitial pregnancy at 10 weeks of gestation, was successfully treated with an ultrasound-guided 100-mg MTX injection after a failed response to 3-dose intramuscular 100-mg MTX treatment (300 mg in total). Regular menstruation occurred 1 month after the local MTX injection. The serum beta-human chorionic gonadotropin level was undetectable 49 days later, and the residual mass had disappeared 6 months later,


CONCLUSIONS
Local injection of MTX may be a good means of managing an unruptured interstitial pregnancy to preserve the entirety of the uterus after failed systemic MTX treatment. Use of a local MTX injection may be a better choice than that of systemic MTX treatment.
Lin
Yu-Shiou
YS
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan.
Chen
Cheng-Li
CL
Yuan
Chiou-Chung
CC
Wang
Peng-Hui
PH
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000328:Adult; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy*; D017211:Treatment Failure; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate