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Management of Interstitial Ectopic Pregnancies With a Combined Intra-Amniotic and Systemic Approach

Swank, Morgan L. MD; Harken, Tabetha R. MD, MPH; Porto, Manuel MD

doi: 10.1097/AOG.0b013e31828d58ee
Case Report

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:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists.