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Laparoscopic salpingocentesis using methotrexate in combination with oral mifepristone for successful treatment of
1Department of Obstetrics and Gynaecology, Princess Royal Hospital, Haywards Heath, West Sussex, United Kingdom. latikaong@yahoo.co.uk
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.
