Treatment of cornual viable pregnancy with single dose methotrexate: Case report

Abstract

We herein report a case of cornual viable pregnancy that was successfully treated with a single dose methotrexate without the need for surgical intervention. A 37 year-old woman was diagnosed cornual pregnancy based on transvaginal ultrasound findings and hormonal assays. A single dose systemic methotrexate (50 mg/m2) was administered. No side effects were experienced. Early diagnosis of interstitial pregnancy can lead to conservative treatment options. Although the most effective methotrexate protocol for conservative treatment is uncertain we concluded that in the hemodynamically stable patient a single dose systemic methotrexate treatment is a useful and should be considered as the first line treatment. This is safe and highly effective management even though viable fetus or high level of human chorionic gonadotropin (B-hCG) was assigned. Hemodynamic stability is the most important criteria and that is directly correlated with the early diagnosis. Surgery can be avoided; however, with conservative management a longer and close follow-up is required.

Keywords

• Cornual pregnancy, methotrexate, treatment, viable

Tek doz metotreksat ile tedavi edilen canlı kornual gebelik: Olgu Sunumu

Öz

Cerrahi müdahaleye gerek kalmadan tek doz metotreksat ile başarılı bir şekilde tedavi ettiğimiz kornual canlı gebeliği olan bir olguyu sunmaktayız. Ultrason bulguları ve horman ölçümleri ile kornual gebelik tanısını koyduğumuz 37 yaşındaki olgumuza tek doz sistemik metotreksat (50 mg/m2) tedavisi uyguladık. Hiç bir yan ekti gözlenmedi. İnterstisyel gebelikte erken tanı konservatif tedavi seçeneklerine imkân sağlar. Her ne kadar konservatif tedavide en etkili metotreksat protokolü belirlenmiş olmasa da hemodinamik olarak stabil olgularda tek doz sistemik metotreksat tedavisinin etkin olduğu söylenebilir ve ilk tedavi seçeneği olarak göz önünde bulundurulabilir. Canlı gebelik veya yüksek düzeyde human koryonik gonadotropin (B-hCG) tespit edilmiş olsa da bu tedavi güvenli ve oldukça efektif bir yöntemdir. En önemli kriter hemodinamik stabilitedir ve bu da doğrudan erken tanı ile ilişkilidir. Cerrahiden kaçınılabilir ancak konservatif tedavilerde daha uzun ve yakın takip gereklidir.

Anahtar Kelimeler

• Kornual gebelik, metotreksat, canlı, tedavi

Kaynakça

1. Vicino M, Loverro G, Resta L, Bettocchi S, Vimercati A, Sel- vaggi L. Laparoscopic cornual excision in a viable large in- terstitial pregnancy without blood flow detected by color Dop- pler ultrasonography. Fertil Steril 2000;74(2):407-9.
2. Siow A, Ng S Laparoscopic management of 4 cases of re- current cornual ectopic pregnancy and review of literature. J Minim Invasive Gynecol 2011;18(3):296-302.
3. Katz D L. Barrett J P. Sanfilippo J S. Badway D M. Combined hysteroscopy and laparoscopy in the treatment of interstitial pregnancy. Am J Obstet Gynecol 2003;188(4)1113-4.
4. Erdem A. Laparoscopic Tubal Surgery [Laparoskopik Tubal Cerrahi]. Türkiye Klinikleri J Gynecol Obst-Special Topics 2008;1(6):11-7.
5. Larraín D, Marengo F, Bourdel N, Jaffeux P, et al. Proximal ectopic pregnancy: a descriptive general population-based study and results of different management options in 86 cas- es. Fertil Steril 2011;95(3):867-71.
6. MacRae R, Olowu O, Rizzuto MI, Odejinmi F. Diagnosis and laparoscopic management of 11 consecutive cases of cornu- al ectopic pregnancy. Arch Gynecol Obstet 2009;280(1):59- 64.
7. Timor-Tritsch IE, Monteagudo A, Matera C, Veit C. Sonograph- ic evaluation of cornual pregnaacies treated without surgery. Obstet Gynecol 1992;79(6):83-7.
8. Brewer H, Gefroh S, Bork M, Munkarah A, Hawkins R, Red- man M. Asymptomatic rupture of a cornual ectopic in the third trimester. J Reprod Med 2005;50(9):715-8.

9. Harika G, Gabriel R,Carre- Pigeon F, et al. Primary applica- tion of three –dimensional ultrasonography to early diagno- sis of ectopic pregnancy .Eur J Obstet Gynecol Reprod Biol 1995;60(2):117-20.
10. Fisch J D. Ortiz B, Tazuke S, Chitkara U, Giudice L. Medical management of interstitial ectopic pregnancy: a case report and literature review. Hum Reprod 1998;13(7):1981-6.
11. Gherman RB, Stitely M, Larrimore C, Nevin K, Coppola A, Wiese D. Low-dose methotrexate treatment for interstitial pregnancy. A case report. J Reprod Med 2000;45(2):142-4.
12. Jermy K, Thomas J, Doo A, Bourne T. The conservative man- agement of interstitial pregnancy. BJOG 2004;111(11):1283- 8.