Source
Department of Obstetrics and Gynaecology, Princess Royal Hospital, Haywards Heath, West Sussex, United Kingdom. latikaong@yahoo.co.uk
Abstract
OBJECTIVE:
To report two cases of women who presented with amenorrhea, lower abdominal pain, and vaginal bleeding and who were diagnosed with advanced interstitial pregnancy after initial negative laparoscopies.
DESIGN:
Case report.
SETTING:
Early pregnancy unit of district general hospital.
PATIENT(S):
A 39-year-old woman with a history of right salpingectomy for ectopic pregnancy and a 28-year-old woman with a history of miscarriage.
INTERVENTION(S):
Laparoscopic salpingocentesis with methotrexate (50 mg/m(2)) after aspiration of an equivalent amount of amniotic fluid. The remainder, based on the calculated dose, was given intramuscularly. Oral mifepristone (200 mg) was given postoperatively.
MAIN OUTCOME MEASURE(S):
Complete resolution of interstitial pregnancy in both instances with two subsequent, successful intrauterine pregnancies delivered at term in the second patient. There were no intraoperative or postoperative complications.
RESULT(S):
Expected decline in beta human chorionic gonadotropin (beta-hCG) levels without the need for any further intervention(s).
CONCLUSION(S):
Interstitial pregnancy may be successfully and safely managed by the use of laparoscopic salpingocentesis with methotrexate and mifepristone despite high initial beta-hCG levels.