Successful multiple-dose methotrexate therapy for unruptured repeat ectopic pregnancy with high β-human chorionic gonadotropin value: a case report

Successfully managing an unruptured ectopic pregnancy necessitates prioritizing the preservation of fertility as the primary objective. Medical management is traditionally considered to be more successful at lower ß- human chorionic gonadotropin (HCG) values. However, there is emerging evidence that successful treatment can be achieved with modification of dosage regimen in the presence of high β-HCG value. We reported the successful management of a case of unruptured repeat ectopic pregnancy in a patient with high β-HCG. Mrs PA is a 25-year-old G4P0+3 with previous right salpingectomy due to ruptured ectopic gestation who presented with an ultrasound diagnosis of unruptured left tubal ectopic gestation at a gestational age of 6 weeks. The pre-treatment quantitative β-HCG level was 7066 IU/l. She had multiple dose methotrexate therapy which was well tolerated with normalization of β-HCG levels within 44 days. Hysterosalpingography done six (6) months post-treatment demonstrated patent left fallopian tube. She subsequently had spontaneous conception of an intrauterine pregnancy 16-months post-treatment. The pregnancy was carried to term and culminated in successful delivery at term. Multiple-dose chemotherapy was successful in this patient with high β-HCG level with no reported adverse effect.