Tratamiento con metotrexate para el embarazo ectópico cornual / Metotrexate Treatment Cornual Ectopic Pregnancy

El embarazo ectópico cornual o intersticial es una entidad rara, con alta morbilidad y mortalidad materna. El objetivo del trabajo es presentar un caso de embarazo ectópico cornual y tratado conservadoramente en el Hospital Ciro Redondo García. Artemisa. Cuba. La paciente es una mujer de 26 años que se atiende por infertilidad secundaria, quien acudió a consulta por amenorrea de 7 semanas, con prueba positiva para hormona gonadotrófica coriónica en orina. La ecografía mostró una imagen compatible con saco gestacional en región cornual derecha sin actividad cardíaca. La cavidad endometrial estaba vacía. Es tratada con dos dosis de metotrexate y conducta expectante. No presentó complicación en relación al embarazo ectópico cornual ni al uso del metotrexate y a los seis meses tuvo un nuevo embarazo que cursó sin complicaciones. El diagnóstico precoz del embarazo ectópico cornual y el uso de metotrexate representan una opción de tratamiento médico conservador y eficaz que evita la intervención quirúrgica(AU)

The cornual ectopic pregnancy is a rare entity, with high morbilidad and maternal mortality. The objective of paper is to present a case of cornual ectopic pregnancy treated conservatively at Ciro Redondo García Hospital, Artemisa, Cuba. The patient is a 26-year-old woman who was treated for secondary infertility, she attended the consultation for amenorrhea of 7 weeks, with positive test for HGC in urine. The ultrasound showed an image compatible with a gestational sac in the right cornual region without cardiac activity. The endometrial cavity was empty. She was treated with two doses of methotrexate and watchful waiting. There was no complication in relation to ectopic cornual pregnancy or the use of methotrexate and at six months. She had a new pregnancy with no complications. The early diagnosis of cornual ectopic pregnancy and the use of methotrexate represent a conservative and effective medical treatment option that avoids surgical intervention(AU)

[Multidose treatment of methotrexate in cornual ectopic pregnancy]. / Protocolo de tratamiento multidosis con metotrexato a pacientes con embarazo-ectópico cornual.

BACKROUND: Ectopic pregnancy represents a common entity when the differential diagnosis of first trimester pathologies is performed. Extratubal location, nonetheless, is an in unfrequent situation that delays and difficults the diagnoses. CASE REPORT: 41-year-old women who goes to clinic for a pregnancy test, which proved positive done. During normal ultrasonographic we observed attached with endometrial 8 mm thick, without gestational sac inside, no free liquid in the bottom of the pouch of Douglas. In the left cornual region had a suggestive image of ectopic pregnancy, of 2.8 cm, with embryo without cardiac activity, tested with Doppler color, according to 6 weeks of amenorrhea was observed. The level of ß-HCG was 17,656 mU/mL, which confirmed the diagnosis of corneal ectopic pregnancy. Multidose protocol of methotrexate and folinic acid was prescribed at a dose of 50 mg on days 1, 3, 5 and 7, and 5 mg in the days 2, 4, 6 and 8, respectively. After 14 days of treatment a new ß-HCG study control was made, which results was 2,519 mU/mL. From that time we take a weekly control studies of the ß-HCG until was negative (six months later). The multidose protocol of methotrexate and folinic acid is an effective treatment in patients with cornual ectopic pregnancy.