title: Laparoscopic salpingocentesis using methotrexate in combination with oral mifepristone for successful treatment of interstitial pregnancy: a case report.
abstract: OBJECTIVE
  To report two cases of women who presented with amenorrhea, lower abdominal pain, and vaginal bleeding and who were diagnosed with advanced interstitial pregnancy after initial negative laparoscopies.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Early pregnancy unit of district general hospital.
  
  
  METHODS
  A 39-year-old woman with a history of right salpingectomy for ectopic pregnancy and a 28-year-old woman with a history of miscarriage.
  
  
  METHODS
  Laparoscopic salpingocentesis with methotrexate (50 mg/m(2)) after aspiration of an equivalent amount of amniotic fluid. The remainder, based on the calculated dose, was given intramuscularly. Oral mifepristone (200 mg) was given postoperatively.
  
  
  METHODS
  Complete resolution of interstitial pregnancy in both instances with two subsequent, successful intrauterine pregnancies delivered at term in the second patient. There were no intraoperative or postoperative complications.
  
  
  RESULTS
  Expected decline in beta human chorionic gonadotropin (beta-hCG) levels without the need for any further intervention(s).
  
  
  CONCLUSIONS
  Interstitial pregnancy may be successfully and safely managed by the use of laparoscopic salpingocentesis with methotrexate and mifepristone despite high initial beta-hCG levels.
authors.affiliation: Department of Obstetrics and Gynaecology, Princess Royal Hospital, Haywards Heath, West Sussex, United Kingdom. latikaong@yahoo.co.uk
authors.forename: Latika
authors.initials: L
authors.lastname: Narang
authors.forename: Gregory
authors.initials: G
authors.lastname: Kalu
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage; D000284:Administration, Oral; D000328:Adult; D000653:Amniotic Fluid; D003131:Combined Modality Therapy; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008727:Methotrexate / Q000008:administration & dosage*; D015735:Mifepristone / Q000008:administration & dosage*; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000188:drug therapy* / Q000601:surgery*; D013396:Suction / Q000379:methods
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D015735:Mifepristone; D008727:Methotrexate