Triple tubal ectopic pregnancy resolution with medical management and outcome

Abstract

Ectopic pregnancy is a life-threatening condition and is rising in incidence due to assisted reproductive techniques in the present era. Three simultaneous implantations in the fallopian tubes is very rare. A 39-year-old G4 A3 was diagnosed to have ectopic pregnancy 42 days after embryo transfer done elsewhere. She had recurrent early pregnancy losses of previous three pregnancies. The first two conceptions were after IUI for prolonged unexplained infertility, and the third pregnancy was spontaneous conception. On the day of admission, she was diagnosed to have two extra uterine gestational sacs of <2 cm on TVS and a β HCG of 4539 mIU/mL. Medical management with variable dose methotrexate was instituted after counseling. Her β HCG rose to 16,125 mIU/L and a review TVS revealed three gestational sacs, two on right side and one on the left side. The third sac measured 1.7 cm × 2.2 cm with small fetal elements after two doses of methotrexate and it was 16,102 mIU/L after completion of one course of methotrexate. She was treated with two doses of 200 mg of mifepristone and was given 2nd course of variable dose of methotrexate and followed by single dose of mifepristone. Her β HCG was 624 mIU/L after 76 days of ET and 33 days of starting therapy. She had spontaneous conception after 2 months of stopping therapy and delivered a healthy baby of 3 kg normally at term.