[Persistent ectopic pregnancy. Peritoneal-uterine late implantation. Case report]

Area of Science:

• Reproductive Medicine
• Gynecologic Surgery
• Medical Therapeutics

Background:

• Ectopic pregnancy, particularly persistent or recurrent forms after initial treatment, poses significant clinical challenges.
• Laparoscopic salpingectomy is a common treatment for fimbrial ectopic pregnancy, but requires careful follow-up for residual trophoblastic activity.

Observation:

• A 31-year-old female presented with persistent elevated human chorionic gonadotropin (hCG) levels and abdominal pain 33 days post-laparoscopic salpingectomy for fimbrial ectopic pregnancy.
• Repeat laparoscopy identified three distinct ectopic implantation sites (one uterine, two peritoneal) exhibiting active trophoblastic cells and intermittent bleeding.

Findings:

• Surgical intervention included fulguration of the implants with bipolar current.
• Intramuscular methotrexate was administered as supplementary therapy, leading to a decline in hCG levels to negative within ten days.

Implications:

• This case underscores that active trophoblastic cells can persist despite thorough surgical review, potentially necessitating urgent intervention.
• Supplementary methotrexate therapy, even a single dose, appears to be a safe and effective option for managing residual trophoblastic disease after surgical treatment of ectopic pregnancy.