The effectiveness of non-surgical management of early interstitial pregnancy: a report of ten cases and review of the literature

Objective To assess the effectiveness of non-surgical management of interst itial pregnancy. Design A prospective interventional study. Subjects Eleven women with the ultrasound diagnosis of interstitial ectopic pregnancy. Methods Women with suspected early pregnancy complications were examined by transvaginal ultrasound. Those with the diagnosis of interstitial pregnanc y were offered non-surgical treatment with methotrexate, which was administ ered systemically or by local injection. Follow-up with regular measurement s of beta-human chorionic gonado-tropin and ultrasound scans continued unti l the pregnancy had resolved completely. Results Ten women were managed non-surgically, and one woman opted for surg ery. Five women received systemic and five local methotrexate. Local therap y was successful in all five cases (100%), whereas four out of five (80%) w omen receiving systemic methotrexate were cured. Significant side-effects w ere noted in two women following systemic therapy In comparison, there were no side-effects in the group of women who received local therapy. There we re no significant differences between the two treatment groups in the lengt h of time taken for the pregnancy to resolve. Conclusions Non-surgical treatment of interstitial pregnancy with methotrex ate appears to be safe and effective. Local administration appears to be mo re successful and better tolerated by patients and may be used as the first -line therapy.