Methotrexate in Interstitial Pregnancy: A Miraculous Fertility Rescuer.

ABSTRACT

Introduction: Interstitial (cornual) gestation is the mosthazardous type of ectopic, where pregnancy gets implantedin the proximal portion of tube that traverses myometrium . Itconstitutes 2-4% of all ectopic pregnancies.It poses a significantdiagnostic and therapeutic challenge and carries a greatermaternal mortality. It usually presents at a later gestation morethan 7-12 weeks .The usual clinical presentation is profuseintraabdominal bleeding and shock. Transvaginal sonographycan be helpful, but often is not conclusive.Case report 21 year old nulliparous lady post laparascopicleft salpingo-oopherectomy, diagnosed to have a liveinterstitial ectopic pregnancy in left lateral wall of uterus withvery high levels of βhCG . She was treated with 2 cycles offolinic acid rescue regime and βhCG monitored accordingly.βhCG showed a decline of 15% initially (2365.9mIU/ml) andweekly βhCG monitored thereafter and reduced to 3.39mIU/ml within 4 months.Conclusion: Cornual resection/hysterectomy used to be thetraditional treatment for these cases. However conservativemanagement has been increasingly practiced successfullyincluding medical treatment with systemic methotrexate andlaparoscopic conservative surgery.