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Updated: Dec 9, 2025

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Methotrexate for Cornual Ectopic Pregnancy.

Barbara M Parker1, Anupam K Gupta2, Anastasios Lymperopoulos3

  • 1Clinical Pharmacy, AdventHealth Orlando and Rockledge Regional Medical Center, Orlando, USA.

Cureus
|September 14, 2020
PubMed
Summary
This summary is machine-generated.

A ruptured ectopic pregnancy in a 27-year-old female initially treated with methotrexate required emergency surgery. Despite initial hCG level decrease, the pregnancy ruptured, leading to a hysterectomy.

Keywords:
cornual pregnancymethotrexate

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Area of Science:

  • Reproductive Endocrinology
  • Surgical Gynecology

Background:

  • Ectopic pregnancy is a life-threatening condition requiring prompt diagnosis and management.
  • Cornual ectopic pregnancies present unique challenges due to their location and potential for rupture.
  • Medical management with methotrexate is a standard treatment option for stable ectopic pregnancies.

Observation:

  • A 27-year-old female presented with pelvic pain and vaginal bleeding, diagnosed with a 4 cm right cornual ectopic pregnancy.
  • Initial treatment involved intramuscular methotrexate, resulting in a significant decrease in human chorionic gonadotropin (hCG) levels.
  • Despite a favorable hCG response, the patient experienced a delayed rupture with hemoperitoneum.

Findings:

  • The patient developed a rupture of the ectopic pregnancy despite initial medical management.
  • Hemoperitoneum necessitated urgent surgical intervention.
  • An exploratory laparotomy revealed the ruptured ectopic pregnancy, leading to an abdominal hysterectomy.

Implications:

  • This case highlights the risk of rupture even after an initial positive response to methotrexate in ectopic pregnancy.
  • Cornual ectopic pregnancies may require heightened surveillance due to their propensity for catastrophic rupture.
  • Multidisciplinary management involving early surgical consultation is crucial for optimizing outcomes in complex ectopic pregnancy cases.