A case of a methotrexate-resistant ectopic pregnancy in which dactinomycin was effective as a second-line chemotherapy.
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.
Fujioka
Satoe
S
Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Osaka, Japan.
Yamashita
Yoshiki
Y
Kawabe
Sachiko
S
Kamegai
Hideki
H
Terai
Yoshito
Y
Ohmichi
Masahide
M
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
D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D003609:Dactinomycin; D008727:Methotrexate