EP21.29: Challenges in therapy: a case study of medically managed ectopic pregnancy at site of previous cornual ectopic pregnancy with wedge resection

Ms YFN, a 29-year-old in her 3rd pregnancy with a history of one previous miscarriage and a wedge resection of a cornual ectopic pregnancy, presented with a 3day history of worsening lower abdominal pain and vaginal spotting 6 weeks after her last menstrual period. She was hemodynamically stable with localised tenderness and guarding in the lower abdomen. Trans-vaginal ultrasound revealed an inhomogeneous mass within the midline fundal myometrium, along with a gestational sac without evidence of an embryo. Laboratory investigations revealed a serum β-HCG of 4295 IU/L. A diagnosis of an ectopic pregnancy at the site of the wedge resection of the previous cornual ectopic pregnancy was made. Considering the diagnosis and the patient's desire for future fertility, the medical team offered both surgical and medical therapy options. Ms. YFN chose medical therapy and underwent an uneventful procedure in which 50mg of methotrexate was injected into the gestational sac under ultrasound guidance. Weekly follow-up showed a steady decline in β-HCG levels to 1759 IU/L, 657IU/ and 347IU/L with the patient remaining asymptomatic. This suggests a positive response to methotrexate treatment, and ongoing monitoring will be necessary to ensure the complete resolution of the ectopic pregnancy. This case highlights the importance of tailored treatment options for ectopic pregnancies, considering the patient's medical history, desires for future fertility, and overall health. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.