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Obstet Gynecol Int. 2009;2009:247452. doi: 10.1155/2009/247452. Epub 2009 Aug 9.

An early abdominal wall ectopic pregnancy successfully treated with ultrasound guided intralesional methotrexate: a case report.

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Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA.


Background. The upper anterior abdominal wall is a very unusual location for an ectopic pregnancy making optimal management uncertain. Case. We report the case of a 26-year-old gravida 4, para 1, aborta 2 with a rising quantitative human chorionic gonadotropin level following a negative diagnostic laparoscopic examination. She was subsequently diagnosed with an abdominal wall ectopic pregnancy 2 cm inferior to the liver. A single percutaneous intralesional injection of methotrexate was successful after initial failure with systemic methotrexate. Conclusion. Systemic methotrexate is a logical first choice for management of a stable early abdominal wall pregnancy. Direct intralesional injection of methotrexate as the next treatment choice may avoid the morbidity linked with operative management.

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