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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?

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 in...

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Autores principales: Sorrentino, Felice, Vasciaveo, Lorenzo, De Feo, Vincenzo, Zanzarelli, Erika, Grandone, Elvira, Stabile, Guglielmo, Nappi, Luigi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9516977/
https://www.ncbi.nlm.nih.gov/pubmed/36141736
http://dx.doi.org/10.3390/ijerph191811464
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author Sorrentino, Felice
Vasciaveo, Lorenzo
De Feo, Vincenzo
Zanzarelli, Erika
Grandone, Elvira
Stabile, Guglielmo
Nappi, Luigi
author_facet Sorrentino, Felice
Vasciaveo, Lorenzo
De Feo, Vincenzo
Zanzarelli, Erika
Grandone, Elvira
Stabile, Guglielmo
Nappi, Luigi
author_sort Sorrentino, Felice
collection PubMed
description 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.
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spelling pubmed-95169772022-09-29 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? Sorrentino, Felice Vasciaveo, Lorenzo De Feo, Vincenzo Zanzarelli, Erika Grandone, Elvira Stabile, Guglielmo Nappi, Luigi Int J Environ Res Public Health Case Report 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. MDPI 2022-09-12 /pmc/articles/PMC9516977/ /pubmed/36141736 http://dx.doi.org/10.3390/ijerph191811464 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Sorrentino, Felice
Vasciaveo, Lorenzo
De Feo, Vincenzo
Zanzarelli, Erika
Grandone, Elvira
Stabile, Guglielmo
Nappi, Luigi
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?
title 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?
title_full 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?
title_fullStr 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?
title_full_unstemmed 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?
title_short 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?
title_sort 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?
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9516977/
https://www.ncbi.nlm.nih.gov/pubmed/36141736
http://dx.doi.org/10.3390/ijerph191811464
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