Methotrexate injection for interstitial pregnancy: Hysteroscopic conservative mini-invasive approach

Area of Science:

• Reproductive Medicine
• Minimally Invasive Surgery
• Gynecologic Oncology

Background:

• Interstitial ectopic pregnancy presents significant maternal risks due to its rarity and unclear optimal treatment.
• Existing management strategies for interstitial pregnancy often carry high morbidity and mortality rates.

Purpose of the Study:

• To evaluate the efficacy and safety of a novel hysteroscopic, ultrasound-guided local methotrexate injection for interstitial ectopic pregnancy.
• To propose a minimally invasive, conservative treatment alternative for interstitial pregnancy.

Main Methods:

• Hysteroscopy was performed under local anesthesia, injecting methotrexate directly into the gestational sac and surrounding myometrium.
• Transabdominal ultrasound (US) guided the procedure and monitored for complications.
• Five patients with interstitial ectopic pregnancy were treated between January 2016 and September 2019.

Main Results:

• The hysteroscopic methotrexate injection technique was successful in all five patients.
• No intraoperative or postoperative surgical complications were observed.
• Tubal patency was confirmed in three patients, and one patient achieved a spontaneous birth post-treatment.

Conclusions:

• The combined hysteroscopic, ultrasound-guided methotrexate injection offers a promising, minimally invasive, and conservative approach for managing interstitial ectopic pregnancy.
• This technique appears to be effective and safe, preserving reproductive potential.