Conservative management of interstitial pregnancy.

A 27-year-old second gravid was admitted with history of amenorrhea of 8 weeks’ duration with lower abdominal pain and spotting per-vaginum of 2 days’ duration. Her vitals were stable, and abdominal examination revealed a soft bulky 6 weeks’ size uterus. Cervical motion tenderness was absent. In view of a positive urine pregnancy test, an urgent transvaginal ultrasound was performed, which revealed an empty uterus with endometrial thickness of 12 mm and a complex adenexal mass of 33 9 32 mm size on the right side (Fig. 1). There was no free fluid in the abdomen. Her b-hCG level was 6,460 mIU/ml. With a provisional diagnosis of ectopic pregnancy, the patient underwent diagnostic laparoscopy which showed an unruptured right-sided interstitial ectopic pregnancy (Fig. 2). Since the patient was keen to preserve her fertility and her general condition remained stable, a conservative medical management was planned for her. She was administered with a two-dose regimen, of intramuscular injection Methotrexate, in the dose of 50 mg/sq m of body surface area, on day 1 and day 4. She was closely monitored for any signs of rupture like pain abdomen, tachycardia, or syncope. She remained asymptomatic and repeat b-hCG value on day 7 showed more than 15 % decline (3,009 mIU/ml), as compared with day 4 levels (3,674 mIU/ml). Hence, the patient was discharged, with advice for weekly follow-up. During the follow-up visit, b-hCG and ultrasound examination was conducted. b-hCG value returned to normal on the 8th visit, and thereafter, the patient was reviewed fortnightly. The complex mass in right cornu resolved after 5 months. Patient was planned for a hysterosalpingography 3 months thereafter, to establish tubal patency. However, she was lost to follow-up.