Spontaneous Twin Ectopic Pregnancy Managed Successfully With Methotrexate-Mediated Ultrasound-Guided Fetal Reduction: A Fertility-Preserving Approach

Ectopic pregnancy has emerged as an alarming problem for obstetricians worldwide. Live twin ectopic conception is rare to occur, and spontaneously conceived twin ectopic pregnancy is even more infrequent. A 32-years-old gravida 3, para 1, live 1, abortion 2, presented with a confirmation of pregnancy on a urinary pregnancy test kit along with pain in the right iliac fossa. Blood investigations revealed raised serum beta-human chorionic gonadotropin hormone. Transvaginal ultrasonography revealed twin ectopic conception in the right fallopian tube with both the embryos showing cardiac activity and no evidence of intrauterine gestational sac. The patient was managed with methotrexate-mediated ultrasound-guided fetal reduction and is doing well on follow-up presently. Hence, our case report highlights the importance of prompt diagnosis and management of twin ectopic pregnancies with the help of newly evolving interventional radiology procedures.