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Case Reports
. 2022 Sep 12;19(18):11464.
doi: 10.3390/ijerph191811464.

Interstitial Pregnancy Treated with Mifepristone and Methotrexate with High Serum β-hCG Level in a Patient Wishing to Preserve Fertility: Time to Define Standardized Criteria for Medical/Surgical Therapy?

Felice Sorrentino  1 , Lorenzo Vasciaveo  1 , Vincenzo De Feo  1 , Erika Zanzarelli  1 , Elvira Grandone  1   2   3 , Guglielmo Stabile  4 , Luigi Nappi  1
Affiliations
Case Reports

Interstitial Pregnancy Treated with Mifepristone and Methotrexate with High Serum β-hCG Level in a Patient Wishing to Preserve Fertility: Time to Define Standardized Criteria for Medical/Surgical Therapy?

Felice Sorrentino et al. Int J Environ Res Public Health. .

Abstract

Interstitial pregnancy (IP) accounts for 2% of all ectopic pregnancies and has a mortality rate of 2-2.5%. The diagnosis is made by a transvaginal ultrasound and the treatment can be medical or surgical. We report the case of a 36-year-old primigravida who was 6 + 5 weeks pregnant, diagnosed with interstitial pregnancy by ultrasound, who had a very high serum β-hCG level (31,298 mIU/mL) and wanted to preserve her fertility. The patient was treated with one dose of mifepristone and a double dose of methotrexate since the decrease in the β-hCG serum level was less than 15% after the first dose. At the beginning, medical therapy was effective, as no embryonal cardiac activity was detected and serum β-hCG levels decreased early, but on the 20th day of hospitalization, the patient underwent surgery for her clinical symptoms and the evidence of free fluid in the Douglas pouch at a transvaginal ultrasound exam. Our experience showed that medical treatment should be considered, especially in women wishing to preserve their fertility. Further studies are needed to establish a standardized protocol and maybe a clinical score that can be useful in predicting the patients in which medical therapy could be most successful.

Keywords: cornuostomy; interstitial pregnancy; medical treatment; methotrexate; mifepristone; non-tubal ectopic pregnancy (EPs); β-hCG.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Transvaginal ultrasound finding of interstitial pregnancy.
Figure 2
Figure 2
Embryo located eccentrically in the right side of the uterine fundus.
Figure 3
Figure 3
3D transvaginal ultrasound showing the interstitial pregnancy.
Figure 4
Figure 4
ꞵ-hCG serum level during hospitalization. On day 1 first methotrexate dose was administered, the second one was given on day 7.
Figure 5
Figure 5
Transvaginal ultrasound control performed on day 15.
Figure 6
Figure 6
Embryo with no cardiac activity on day 15.
Figure 7
Figure 7
3D transvaginal ultrasound scan performed on day 15 showing the interstitial pregnancy.
Figure 8
Figure 8
Laparotomic view of cornuectomy after interstitial pregnancy uterine rupture.
See this image and copyright information in PMC

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