A CASE OF AMPULLARY ECTOPIC GESTATION FOLLOWING TUBAL RECANALISATION - FAILED METHOTREXATE THERAPY

Abstract

Ectopic pregnancy is an important cause of           maternal mortality and morbidity. Overall, 70 percent of          ectopic pregnancies are located in the tubal ampulla, 12  percent in the isthmus, 11 percent in the fimbria, and 2           percent in the interstitial segment. Medical management of an unruptured ectopic pregnancy with methotrexate is a common and effective method and alternative to surgery. Early           diagnosis and proper intervention by the methotrexate has brought down the morbidity and mortality. Here, we present a case of a 26 years old para 2 living 1 who had undergone tubal recanalization came to department of obstetrics and gynaecology , with missed periods. On examinations she was not pale but had a small palpable mass in the left iliac fossa. Patient was investigated with transvaginal scan and serum beta hCG and started on conservative medical management which was failed and proceded with surgical                           management. Thus, we conclude a failed methotrexate           therapy in ectopic pregnancy is a challenge to all clinicians. Always should have a high index of suspicion of ectopic  pregnancy in recanalization patients and proper selection of the candidate.