Interstitial Pregnancy -Conservative Management by Systemic Methotrexate

Abstract

Background: Interstitial pregnancy poses a great diagnostic and therapeutic challenge and carries a high maternal mortality. Because of myometrial distensibility, they tend to present late when rupture occurs. But, when diagnosed early, it can be managed conservatively.Case: A case of unruptured interstitial pregnancy diagnosed early on pelvic ultrasound, with high serum β hCG levels and managed by single dose systemic methotrexate is presented. Returning of serum β hCG to non pregnant levels and disappearance of ectopic mass occurred after 3 months of methotrexate administration. Conclusion:Early diagnosis of interstitial pregnancy could lead to successful conservative medical management and avoids the life threatening complication of rupture and surgery. In a hemodynamically stable patient of interstitial pregnancy, systemic methotrexate can be a safe option even with high β hCG concentration but long term monitoring and patience is required.