Medical Management of Interstitial Ectopic Pregnancy With Multidose Methotrexate

Interstitial ectopic pregnancy is a rare and potentially life-threatening type of ectopic pregnancy. Its location within the myometrial portion of the fallopian tube poses diagnostic challenges and increases the risk of hemorrhage upon rupture. We report the case of a 30-year-old primigravida who presented with lower abdominal pain and per vaginal spotting at approximately six weeks of gestation. Imaging confirmed a left interstitial ectopic pregnancy. She was hemodynamically stable and fulfilled the criteria for medical management. A multidose methotrexate regimen was administered, with serial monitoring of beta-hCG (human chorionic gonadotropin) and ultrasound findings. She received four doses of methotrexate. Her beta-hCG levels progressively declined, and imaging confirmed resolution. She remained stable throughout and resumed menstruation 26 days post-treatment. This case highlights the feasibility of medical management in interstitial ectopic pregnancy with strict monitoring protocols. Early diagnosis, appropriate patient selection, and fertility-preserving treatment strategies can lead to successful outcomes without surgical intervention.