A case of unilateral twin tubal pregnancy treated by


R.S. Karadeniz, S. Dilbaz, S. Deveci, B. Dilbaz, F. Ercan, T Kinay,

A. Tarcan

Ministry of Health, Etlik Maternity and Women’s Health Research and

Teaching Hospital, Ankara, Turkey

Introduction Twin ectopic pregnancy (EP) is

an extremely rare entity and among 100 reported cases methotrexate (MTX)

treatment has not being reported yet. The incidence of EP is increasing with the

wide use of assisted reproductive technologies (ART). Early diagnosis and

intervention is important to in prevent short and long term morbidity.

Case A 26-year-old nulliparous woman was admitted to the hospital with a complaint of

vaginal bleeding and pelvic pain. She had ovulation induction with

gonadhotropins and an emergency admission was carried out as there was left

adnexial tenderness without acute abdomen signs on pelvic examination. The serum

levels of beta-hCG, Hb, WBC, platelet count, ALT and AST were 763 IU/ml, 12

mg/dl, 9060/mm3, 236.000, mm3, 16 and 21 U/L on admission. Two separate tubal

pregnancies with a diameter of 17x10mm and 16x10mm were detected in the left

tube during transvaginal ultrasonographic examination. There were two

predisposing factors for ectopic pregnancy in her history; smoking and a five

year history of primary infertility . On the third day of hospital admission,

multiple dose MTX regimen (1 mg/kg MTX on days 1,3,5 and 7, + 0,1 mg/kg Folinic

acid on days 2,4,6 and 8) was started when beta-hCG level was 987 IU/ml. On the

3rd day an endometrial sampling was performed and endometrium without chorionic

villus was reported from pathology department. Labeling the day when the

treatment was initiated as Day-1 the serum levels of beta-hCG were as follows:on

the Day-3=1091 IU/ml, Day-7=750 IU/ml. color doppler sonography on the third day

of treatment showed PI:1,95 and RI:0,78 values in tubal plasentation. A single

dose of MTX (1 mg/kg) was applied at Day-12 again as the beta-HCG level was

increased to 1200 IU/ml. Serum beta-hCG level was regressed to normal range 32

days after iniation of MTX treatment.

Conclusion Patients with unilateral twin

tubal pregnancies in literature were managed successfully by operative

procedures like; laparoscopic/ laparatomic salpingostomy or total salpingectomy.

This is a pioneering report of a successful MTX use in unilateral twin tubal


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