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Interstitial Pregnancy Treated with Mifepristone and Methotrexate with High Serum β-hCG Level in a Patient Wishing to Preserve Fertility: Time to Define Standardized Criteria for Medical/Surgical Therapy?

Author

Listed:
  • Felice Sorrentino

    (Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy)

  • Lorenzo Vasciaveo

    (Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy)

  • Vincenzo De Feo

    (Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy)

  • Erika Zanzarelli

    (Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy)

  • Elvira Grandone

    (Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
    Thrombosis and Haemostasis Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy
    Ob/Gyn Department of the First I.M. Sechenov Moscow State Medical University, 119991 Moscow, Russia)

  • Guglielmo Stabile

    (Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy)

  • Luigi Nappi

    (Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy)

Abstract

Interstitial pregnancy (IP) accounts for 2% of all ectopic pregnancies and has a mortality rate of 2–2.5%. The diagnosis is made by a transvaginal ultrasound and the treatment can be medical or surgical. We report the case of a 36-year-old primigravida who was 6 + 5 weeks pregnant, diagnosed with interstitial pregnancy by ultrasound, who had a very high serum β-hCG level (31,298 mIU/mL) and wanted to preserve her fertility. The patient was treated with one dose of mifepristone and a double dose of methotrexate since the decrease in the β-hCG serum level was less than 15% after the first dose. At the beginning, medical therapy was effective, as no embryonal cardiac activity was detected and serum β-hCG levels decreased early, but on the 20th day of hospitalization, the patient underwent surgery for her clinical symptoms and the evidence of free fluid in the Douglas pouch at a transvaginal ultrasound exam. Our experience showed that medical treatment should be considered, especially in women wishing to preserve their fertility. Further studies are needed to establish a standardized protocol and maybe a clinical score that can be useful in predicting the patients in which medical therapy could be most successful.

Suggested Citation

  • Felice Sorrentino & Lorenzo Vasciaveo & Vincenzo De Feo & Erika Zanzarelli & Elvira Grandone & Guglielmo Stabile & Luigi Nappi, 2022. "Interstitial Pregnancy Treated with Mifepristone and Methotrexate with High Serum β-hCG Level in a Patient Wishing to Preserve Fertility: Time to Define Standardized Criteria for Medical/Surgical Ther," IJERPH, MDPI, vol. 19(18), pages 1-9, September.
  • Handle: RePEc:gam:jijerp:v:19:y:2022:i:18:p:11464-:d:912745
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    References listed on IDEAS

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    1. Guglielmo Stabile & Federico Romano & Giulia Zinicola & Ghergana Alexandrova Topouzova & Giovanni Di Lorenzo & Francesco Paolo Mangino & Giuseppe Ricci, 2021. "Interstitial Ectopic Pregnancy: The Role of Mifepristone in the Medical Treatment," IJERPH, MDPI, vol. 18(18), pages 1-9, September.
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