title: A case of a methotrexate-resistant ectopic pregnancy in which dactinomycin was effective as a second-line chemotherapy.
abstract: OBJECTIVE
  To report a case of a methotrexate (MTX)-resistant heterotopic interstitial pregnancy in which dactinomycin was necessary as a second-line chemotherapy.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Medical college-affiliated hospital.
  
  
  METHODS
  A 39-year-old woman with vaginal bleeding after the transfer of two thawed 8-cell embryos.
  
  
  METHODS
  MTX 50 mg/m(2) was given to the patient to treat a concomitant pregnancy in which an interstitial pregnancy and an intrauterine blighted ovum were identified. However, the patient's hCG level rose despite two MTX administrations. As a result, dactinomycin was then administered as a second-line chemotherapy. The patient's serum hCG level declined to a normal range after two administrations of dactinomycin.
  
  
  CONCLUSIONS
  Dactinomycin could be an alternative in cases for which MTX is not effective and persistently high hCG levels exist.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: Satoe
authors.initials: S
authors.lastname: Fujioka
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Sachiko
authors.initials: S
authors.lastname: Kawabe
authors.forename: Hideki
authors.initials: H
authors.lastname: Kamegai
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Terai
authors.forename: Masahide
authors.initials: M
authors.lastname: Ohmichi
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal; D000028:Abortion, Induced; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D003609:Dactinomycin; D004351:Drug Resistance; D004624:Embryo Transfer; D005260:Female; D006801:Humans; D008727:Methotrexate; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000628:therapy*; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D003609:Dactinomycin; D008727:Methotrexate