A Case Report on Successful Medical Intervention with Methotrexate for Management of Ectopic Twin Pregnancy

An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, which can involve one or more embryos. A recent study indicated that unilateral twin tubal pregnancies have an occurrence rate of 1 in 20,000 to 1 in 250,000. To date, 106 cases of ectopic twin pregnancies have been identified, but this number is likely underestimated, as many cases are diagnosed during surgery. Management options include expectant, medical, or surgical approaches. Expectant management is for patients who are stable with a declining or steady serum beta-human chorionic gonadotropin (b-hCG) level. Medical management typically involves administering methotrexate (MTX) through various methods and is also reserved for stable patients. Surgical options include salpingectomy or salpingostomy, often performed laparoscopically for stable patients and via laparotomy for those who are unstable. New surgical techniques are emerging but are not well-studied for twin ectopic pregnancies.

Research shows no significant difference in success rates between expectant, medical, and surgical management for singleton ectopic pregnancies, although data on twin pregnancies is limited. In a reported case, a 24-year-old woman with a history of previous pregnancies presented with symptoms indicative of an ectopic pregnancy. She was diagnosed via ultrasound, revealing a left adnexal ectopic pregnancy, and chose medical management with MTX. After monitoring her b-hCG levels and symptoms, she received a second dose of MTX due to the persistence of the ectopic pregnancy. Ultimately, she experienced a successful resolution of her twin ectopic pregnancies.

This case emphasizes the potential for effective medical management of unilateral tubal twin pregnancies using two doses of MTX, highlighting the need for careful monitoring and follow-up. The medical profession is still debating the best ways to treat ectopic pregnancies, especially in light of potential future fertility and surgical methods.

Source: Forbes LA, Nuthivana N, Morales R. Successful Management of Spontaneous Unilateral Twin Ectopic Pregnancy With Two-Step Dose of Methotrexate. Case Rep Obstet Gynecol. 2024 Aug 19;2024:5543780. doi: 10.1155/2024/5543780. PMID: 39188358; PMCID: PMC11347029.

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