title: Interstitial pregnancy treated by transcervical aspiration of the gestational sac combined with systemic and local administration of methotrexate.
abstract: Interstitial pregnancy, which is a rare form of tubal ectopic pregnancy, can grow larger than those within the fallopian tube because the surrounding myometrium is more expandable than the tube; many cases are advanced and treated with surgical resection or a large amount of methotrexate (MTX). This report presents a case of an advanced interstitial pregnancy treated with systemic MTX and laparoscopic local MTX injection combined with transcervical aspiration of the gestational sac. A 27-year-old nulliparous female presented with an interstitial pregnancy. Serum human chorionic gonadotropin (hCG) level was 90000 IU/L. MTX was given systemically (50 mg/m(2) i.m.) and the gestational sac was aspirated transcervically under laparoscopic guidance followed by local injection of 25 mg MTX. The patient received a total of only 95 mg MTX. The gestational sac disappeared and serum hCG became undetectable. The patient became pregnant spontaneously six months later, and delivered a live 2482-g infant in good condition by planned cesarean section at 36 weeks and 3 days of gestation. No defect of the myometrium was seen during the surgery. This therapy may be effective for interstitial pregnancy and can be performed safely with laparoscopy.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan.
authors.forename: Sousuke
authors.initials: S
authors.lastname: Kato
authors.forename: Tomohito
authors.initials: T
authors.lastname: Tanaka
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Terai
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Masahide
authors.initials: M
authors.lastname: Ohmichi
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects; D000032:Abortion, Therapeutic / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic; D013396:Suction
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate