A CASE REPORT ON FAILURE OF MEDICAL MANAGEMENT OF TUBAL ECTOPIC PREGNANCY

Dr. Radhika Parmar

Abstract


Ectopic pregnancy remains the leading cause of early pregnancy related deaths. Medical management is preferred for most ectopic pregnancy with methotrexate extensively as an alternative to surgical management. Over 87% of treated cases with methotrexate by multi-dose therapy has successful outcome. Prior to medical therapy, certain pre-requisites are required to be fulfilled for successful outcome of medical therapy such as hemodynamic stability, initial serum beta-hCG levels(<5000 IU), ectopic gestational sac size(<3.5 cm) and absent fetal cardiac activity. Not fulfillment of these criterions may lead to failure of medical therapy. We present a case of 28 years old female presented to emergency department with complains of abdominal pain, bleeding P/V with 6 weeks of pregnancy. She was hemodynamically stable with serum beta-hCG levels 4280 IU. On USG-Pelvis: empty uterine cavity, 0.9X1.1 cm sized gestational sac with internal yolk sac like structure with PRESENT fetal cardiac activity in right adnexa suggestive of RIGHT SIDED TUBAL ECTOPIC PREGNANCY. She underwent medicalĀ  multidose methotrexate therapy, but there was no fall of beta-hCG levels, so she was treated with laparoscopic right sided partial salpingectomy.


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