Twin tubal and interstitial ectopic pregnancies managed by multidose methotrexate therapy

Introduction: Twin ectopic pregnancy is a rare diagnosis with no clear consensus guidelines for management. We present a case of a stable patient with a spontaneous twin interstitial and tubal ectopic pregnancy treated with systemic multidose methotrexate. Case Report: A 31-year-old nulliparous patient was diagnosed with a twin interstitial and tubal ectopic pregnancy after presenting at 6+1 weeks gestational age with a β-hCG of 2303 mIU/mL, vaginal spotting, and mild pain. Given the case characteristics and hemodynamic stability, she was managed with systemic multidose methotrexate and leucovorin rescue. She remained clinically stable and her β-hCG became undetectable on day 42 after treatment initiation. Conclusion: Multidose methotrexate therapy is a suitable treatment option for carefully selected patients with twin ectopic pregnancies who are hemodynamically stable.