BACKGROUND: Approximately 2% of all pregnancies are ectopic; of these, 4% are interstitial or cervical. There exists no clear consensus as to whether surgical or medical management is superior.
CASE: We present three cases of advanced nonfallopian tube ectopic pregnancies from 6 to 8 weeks of gestation. Our first two cases were managed with a combined intrafetal, intra-amniotic and systemic approach using methotrexate and potassium chloride, whereas our third case was managed with an intra-amniotic approach alone. Our combined approach cases were successful, with resolution of human chorionic gonadotropin in 50 and 34 days, whereas our single approach case re-presented with bleeding requiring uterine artery embolization and operative removal of products of conception.
CONCLUSION: Patients presenting with advanced interstitial or cervical pregnancies who are clinically stable can be offered medical management with a combined approach.
Treatment of advanced cervical and interstitial ectopic pregnancies with a combined intra-amniotic and multi-dose systemic regimen allows for successful conservative management.
Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California.
Corresponding author: Morgan L. Swank, MD, University of California, Irvine, Department of Obstetrics–Gynecology, 101 The City Drive, Suite 800, Building 56, ZOT 3200, Orange, CA 92868; e-mail: email@example.com.
Financial Disclosure The authors did not report any potential conflicts of interest.