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.
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.
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: firstname.lastname@example.org.
Financial Disclosure The authors did not report any potential conflicts of interest.