Preoperative Methotrexate in Broad-Ligament Pregnancy: Is There a Role?

Abstract

Background: Broad-ligament pregnancy is an extremely rare event that may be difficult to diagnose. Treatment of broad-ligament pregnancy conventionally involves immediate laparotomy with excision of the fetus. This procedure which has a propensity to cause hemorrhage. Case: A 27-year-old gravida 3 para 2 L2 at 20 weeks of gestation presented with abdominal pain that had lasted 3 weeks prior to presentation and was suspected to have a broad-ligament pregnancy as noted on ultrasound and magnetic resonance imaging. Methotrexate was administered intramuscularly at a dose of 50 mg (1 mg/kg), 24 hours prior to elective surgery, as this patient was hemodynamically stable. Extraction of the fetus and placenta was carried out during the laparotomy. The patient's total intraoperative blood loss was approximately 600 mL and she did not require any blood transfusion. Results: Her postoperative period was uneventful, and she was discharged to go home on the eighth postoperative day. Conclusions: Preoperative systemic methotrexate in a hemodynamically stable patient might minimize blood loss and is a reasonable option for managing broad-ligament pregnancy. ( J GYNECOL SURG 29:102)