Live twin tubal ectopic pregnancy after ovulation induction / 대한산부인과학회지

ABSTRACT

Twin tubal ectopic pregnancy is rare. Especially the live twin tubal ectopic pregnancy is extremely rare, just 10 cases have been reported until now. There were 9 cases of live twin tubal pregnancy after spontaneous conception and one case after IVF cycle. This is the first report of live twin tubal ectopic pregnancy after ovulation induction with clomiphene citrate. A 31-year-old woman, nulligravida complained of primary infertility and irregular menstruation. After ovulation induction with clomiphen citrate, beta-hCG was 1566 mIU/mL on missed period of 5 weeks 4 days. On 6(+1) weeks, beta-hCG was elevated to 3446 mIU/mL and transvaginal ultrasound revealed two separated gestational sacs, each containing yolk sac in the left tube. The variable dose of methotrexate therapy was tried using 1 mg/kg of methotrexate and 0.1 mg/kg of leukovorin. These were injected alternatively for 8 days. On 7(+3) weeks, beta-hCG was elevated to 8,029 mIU/mL and transvaginal ultrasound revealed two fetal poles with heart beat in each gestational sacs. Laparoscopic salpingectomy was performed. The diagnosis was confirmed by the operative finding and also in the pathologic report. It is needed that careful ultrasonographic examination especially in the case of ovulation induction or IVF-ET. Methotrexate treatment in twin tubal pregnancy was usually failed. There was only one successful report by the direct injection of methotrexate to the fallopian tube combined with single intramuscular injection. Further research for dosage or route of administration will be needed.