A case of unilateral twin tubal pregnancy treated by
methotrexate
R.S. Karadeniz, S. Dilbaz, S. Deveci, B. Dilbaz, F. Ercan, T Kinay,
A. Tarcan
Ministry of Health, Etlik Maternity and Women’s Health Research and
Teaching Hospital, Ankara, Turkey
Introduction Twin ectopic pregnancy (EP) is
an extremely rare entity and among 100 reported cases methotrexate (MTX)
treatment has not being reported yet. The incidence of EP is increasing with the
wide use of assisted reproductive technologies (ART). Early diagnosis and
intervention is important to in prevent short and long term morbidity.
Case A 26-year-old nulliparous woman was admitted to the hospital with a complaint of
vaginal bleeding and pelvic pain. She had ovulation induction with
gonadhotropins and an emergency admission was carried out as there was left
adnexial tenderness without acute abdomen signs on pelvic examination. The serum
levels of beta-hCG, Hb, WBC, platelet count, ALT and AST were 763 IU/ml, 12
mg/dl, 9060/mm3, 236.000, mm3, 16 and 21 U/L on admission. Two separate tubal
pregnancies with a diameter of 17x10mm and 16x10mm were detected in the left
tube during transvaginal ultrasonographic examination. There were two
predisposing factors for ectopic pregnancy in her history; smoking and a five
year history of primary infertility . On the third day of hospital admission,
multiple dose MTX regimen (1 mg/kg MTX on days 1,3,5 and 7, + 0,1 mg/kg Folinic
acid on days 2,4,6 and 8) was started when beta-hCG level was 987 IU/ml. On the
3rd day an endometrial sampling was performed and endometrium without chorionic
villus was reported from pathology department. Labeling the day when the
treatment was initiated as Day-1 the serum levels of beta-hCG were as follows:on
the Day-3=1091 IU/ml, Day-7=750 IU/ml. color doppler sonography on the third day
of treatment showed PI:1,95 and RI:0,78 values in tubal plasentation. A single
dose of MTX (1 mg/kg) was applied at Day-12 again as the beta-HCG level was
increased to 1200 IU/ml. Serum beta-hCG level was regressed to normal range 32
days after iniation of MTX treatment.
Conclusion Patients with unilateral twin
tubal pregnancies in literature were managed successfully by operative
procedures like; laparoscopic/ laparatomic salpingostomy or total salpingectomy.
This is a pioneering report of a successful MTX use in unilateral twin tubal
pregnancy