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Successful Management of Live Ectopic Pregnancy with High B-Hcg Titres by Systemic Methotrexate Injection: A Case Report

Author(s): Asieh Maleki, Amin Maleki, Kimia HasanZadeh

Background: Use of methotrexate (MTX) as a nonsurgical management of unruptured ectopic pregnancies has been well accepted. However, use of it in high serum chorionic gonadotropin concentration and in live fetus has been considered as relative contraindication for medical therapy. The aim of this report is to emphasize that these contraindications can be revisable in some situations and discuss about this fact that the success rate can be affected by the type of protocols used for medical treatment.

Case presentation: A 31 years old primigravid woman was admitted to our hospital due to a sonogram's report of ectopic pregnancy with a high initial serum B-hCG concentration (26900) and presence of fetal cardiac activity. Her vital signs were stable and she did not agree with operative intervention. Two-dose protocol was scheduled but appropriate response to treatment was obtained after receiving the third dose of methotrexate. Negative serum B-hCG (< 1 mIu/ml) was achieved on day 80 without any related treatment complication on follow up.

Conclusions: Use of double- dose protocols of MTX in medical treatment of ectopic pregnancy increase the chance of successful and nonsurgical treatment even in live fetus with high B-hCG titers.

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