Interstitial ectopic pregnancy - management with laparoscopically-guided local methotrexate infiltration

EDITORIAL COMMENT: This issue of the journal contains 2 case reports of interstitial ectopic pregnancies, both treated by injection of methotrexate, by intramuscular injection in one case, and by laparoscopically-guided injection into the ectopic pregnancy mass in the other. The methods were not equally successful. Parker and colleagues reviewed the published data and concluded that single-dose intramuscular methotrexate for treatment of ectopic pregnancy is associated with a high failure rate, and serious complications have occurred (11). The authors of this report advocate the use of laparoscopically-guided local methotrexate infiltration. The selection of which cases of ectopic pregnancy warrant this regimen is not yet established in the editor's opinion. Ironically one of the reviewers of this case report, selected because of his known experience with ultrasonographically-guided direct local methotrexate injection into early tubal ectopic pregnancies, stated that, because of the risk of causing haemorrhage, that he had preferred methotrexate by intramuscular injection in 2 women with interstitial ectopic pregnancies, who then, at a later date, had excision of the ectopic pregnancies performed laparoscopically. Summary: This case describes the use of ultrasound to diagnose an interstitial ectopic pregnancy and the subsequent management and ultrasound follow-up. Interstitial pregnancy is a rare but potentially life-threatening complication of pregnancy. Management options depend upon the timing of diagnosis, and the desire for maintenance of fertility. Methotrexate injection, under ultrasonographic or laparoscopic guidance, seems to be the management of choice when the ectopic is diagnosed at an early stage.Chris Wilkinson, Oswald Petrucco, Maureen Pachulicz and Margaret Furnes