The Success of the Single-Dose Methotrexate Treatment in an Atypical Heterotopic Pregnancy

Heterotopic pregnancy refers to simultaneous presence of intrauterine and ectopic gestational sacs. Its incidence exhibits a rising trend due to the increased use of assisted reproductive technology (ART). This paper aims to present a rare case of tubal and cesarean scar heterotopic pregnancy that occurred following a spontaneous pregnancy. The patient presenting with delayed menstruation and abdominal-inguinal pain was evaluated. Transvaginal ultrasonography revealed a gestational sac located in the scar of a previous cesarean section and in the left tubal region corresponding to a gestational age of 4 weeks and 5 days. The patient was hospitalized and informed about conservative and surgical methods. Then, she was administered a single dose of methotrexate 75 mg intramuscularly. Post-operative period included ultrasonographic and laboratory follow-up. In conclusion, it should be remembered that single-dose systemic methotrexate therapy might constitute an alternative to surgery in unruptured hemodynamically stable cases. J Clin Exp Invest 2016; 7 (2): 200-202

Keywords:

heterotopic pregnancy, ectopic pregnancy, methotrexate β-hCG,

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1. Evsen MS, Soydinç HE. Acil jinekolojik operasyonlar: 105 olgunun değerlendirilmesi. J Clin Exp Invest. 2010;1:12-5. 2. Telci S, Kaya C, Yasar L, Ekin M. Spontaneous heterotopic pregnancy causing tubal rupture in a patient with intrauter - ine device in-situ. Bakırköy Tıp Dergisi 2014;10:121-123. 3. Luo X, Lim CE, Huang C, et al. Heterotopic pregnancy fol - lowing in vitro fertilization and embryo transfer: 12 cases report. Arch Gynecol Obste. 2009;280:325-9. 4. Hassiakos D, Bakas P, Pistofidis G, Creatsas G. Hetero - topic pregnancy at 16 weeks of gestation after in-vitro fertilization and embryo transfer. Arch Gynecol Obstet. 2002;266:124-5. 5. Tal J, Haddad S, Gordon N, Timor-Tritsch I. Heterotopic pregnancy after ovulation induction and assisted reproduc - tive technologies: a literature review from 1971-1993. Fer - til Steril. 1996;66:1-12. 6. Arıöz DT, Çelik F, Polat C. Heterotopik gebelik: Olağandışı bir akut batin nedeni. Kocatepe Tıp Dergisi. 2008;9:1-3. 7. Seidman DS, Levran D, Ben-Rafael Z, et al. The incidence of combined intrauterine and extrauterine pregnancy af - ter in vitro fertilization and embryo transfer. Fertil Steril. 1991;55:833-4. 8. Reece ED, Petrie RH, Sirmons MF, et al. Combined intra - uterine and extrauterine gestation: a review. Am J Obstet Gynecol. 1983;146:323-330. 9. Glassner MJ, Aron E, Eskin BA. Ovulation induction with clomiphene and rise in heterotopic pregnancies: a report of two cases. J Reprod Med. 1990;35:175-178. 10. Lavanya R, Deepika K, Madhuri P. Successful pregnancy following medical management of heterotopic pregnancy. J Hum Reprod Sci. 2009;2:35-40. 11. Baxi A, Kaushal M, Karmalkar H, et al. Successful expect - ant management of tubal heterotopic pregnancy. J Hum Re - prod Sci. 2010;3:108-10. 12. Parker J, Thompson D. Persistent ectopic pregnancy after conservation management successful treatment with single- dose intramusculer MTX. Obstet Gynecol. 1994;34:99-102. 13. Lipscomb GH, McCord Ml, Stovall TG, et al. Predictors of success of methotrexate treatment in women with tubal ectopic preganancies. N Engl J Med. 1999;341:1974-8. 14. The American College of Obstetricians and Gynecologists Medical management of tubal pregnancy. Clinical Manage - ment Guidelines, 1998; Number 3. 15. Barnhart KT, Gosman G, Ashby R, Sammel M. The medical management of ectopic pregnancy: a meta analysis compar - ing’ single dose and multidose’ regimens. Obstet Gynecol. 2003;101:778-84.