Management of Interstitial Ectopic Pregnancies With a Combined Intra-Amniotic and Systemic Approach

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 122; no. 2, PART 2; pp. 461 - 464
• Main Authors: Swank, Morgan L, Harken, Tabetha R, Porto, Manuel
• Format: Journal Article
• Language: English
• Published: United States by The American College of Obstetricians and Gynecologists 01.08.2013
• Subjects: Abortifacient Agents, Nonsteroidal - administration & dosage; Abortifacient Agents, Nonsteroidal - therapeutic use; Adult; Chorionic Gonadotropin - blood; Female; Humans; Methotrexate - administration & dosage; Methotrexate - therapeutic use; Potassium Chloride - therapeutic use; Potassium Compounds - therapeutic use; Pregnancy; Pregnancy, Ectopic - drug therapy; Uterine Artery Embolization; Uterine Hemorrhage - etiology; Uterine Hemorrhage - therapy; Young Adult
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0b013e31828d58ee

BACKGROUND:Approximately 2% of all pregnancies are ectopic; of these, 4% are interstitial or cervical. There exists no clear consensus as to whether surgical or medical management is superior. CASE:We present three cases of advanced nonfallopian tube ectopic pregnancies from 6 to 8 weeks of gestation. Our first two cases were managed with a combined intrafetal, intra-amniotic and systemic approach using methotrexate and potassium chloride, whereas our third case was managed with an intra-amniotic approach alone. Our combined approach cases were successful, with resolution of human chorionic gonadotropin in 50 and 34 days, whereas our single approach case re-presented with bleeding requiring uterine artery embolization and operative removal of products of conception. CONCLUSION:Patients presenting with advanced interstitial or cervical pregnancies who are clinically stable can be offered medical management with a combined approach.