Heterotopic abdominal pregnancy with persistent trophoblastic tissue

Area of Science:

• Reproductive Medicine
• Obstetrics and Gynecology
• Clinical Case Reports

Background:

• Heterotopic pregnancy, characterized by simultaneous intrauterine and ectopic gestations, is an increasingly recognized complication of assisted reproductive technology (ART).
• While often diagnosed early, cases involving advanced abdominal pregnancy present significant management challenges due to risks of hemorrhage and maternal/fetal compromise.

Observation:

• A 37-year-old nulliparous woman undergoing ART presented with a heterotopic pregnancy diagnosed at 12 weeks, with an intrauterine pregnancy and an abdominal pregnancy.
• Following surgical resection of the abdominal pregnancy, persistent ectopic trophoblastic tissue was noted on the bowel serosa, mesentery, and omentum, posing a high risk of bleeding.

Findings:

• Systemic methotrexate was administered at a low dosage regimen to manage the persistent ectopic trophoblastic tissue and mitigate bleeding risks.
• The intrauterine pregnancy continued to progress favorably, and a live infant was successfully delivered at 27 weeks and 3 days gestation.
• No immediate fetal toxicity was observed with the low-dose systemic methotrexate treatment.

Implications:

• This case suggests that low-dose systemic methotrexate can be a therapeutically beneficial option for managing persistent ectopic trophoblastic tissue in complex heterotopic pregnancies following ART.
• The findings support the cautious use of methotrexate in specific scenarios to preserve viable intrauterine pregnancies while addressing residual ectopic disease, minimizing maternal complications.
• Further research into optimal dosing and safety profiles of methotrexate in advanced heterotopic pregnancies is warranted.