Abstract
Interstitial ectopic pregnancies are very rare, however, they are extremely dangerous. Treatment consists of either surgical or medical management. This patient presented with no prior pregnancies, an inappropriately rising b-hCG, and eventually had ultrasound findings consistent with interstitial ectopic pregnancy. She was seen through the Emergency Department and had no insurance. She strongly desired to avoid surgery, and was successfully given a multi-dose regimen of methotrexate. Contraindication to methotrexate management includes an inability to follow-up, so a close therapeutic alliance was maintained to enable safe resolution of this case. She has since successfully carried an uncomplicated intrauterine pregnancy to term.
Highlights
The rate of ectopic pregnancy in the general population is 2% of all pregnancies
If the diagnosis is uncertain in a stable patient, MRI could be considered. This case report describes an interstitial ectopic pregnancy in a 19 yo G1P0 successfully treated with multi-dose treatment with IM methotrexate alternating with folinic acid rescue
Several medical techniques were discussed, and a plan was made for Interventional Radiology (IR) guided injection of methotrexate
Summary
The rate of ectopic pregnancy in the general population is 2% of all pregnancies. Risk factors for ectopic pregnancy include pelvic inflammatory disease, previous ectopic pregnancy, tubal surgery, assisted reproductive techniques (with two or more embryos transferred), and congenital uterine anomalies [1] [2]. The interstitial portion of the fallopian tube is about 2 cm long and 0.7 mm wide and is highly vascular as it is located at the junction of the uterus and the proximal part of the fallopian tube [7] It has abundant blood supply from both the uterine and ovarian vessels and rupture and hemorrhage are more likely to lead to mortality [5] [6]. These pregnancies tend to be diagnosed at a later gestational age, between six and twelve weeks, as the blood supply and distensibility of the architecture can support growth for a longer period of time These pregnancies are sometimes incorrectly referred to as cornual pregnancies, a term which describes conceptions in patients with Mullerian abnormalities [6] [7]. This case report describes an interstitial ectopic pregnancy in a 19 yo G1P0 successfully treated with multi-dose treatment with IM methotrexate alternating with folinic acid rescue
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