# Effective Local Methotrexate Therapy for Interstitial Ectopic Pregnancy: A Case Report and Review of the Literature

## TL;DR

A rare ectopic pregnancy was successfully treated with local methotrexate injection after initial systemic treatment failed.

## Contribution

The novel use of direct local methotrexate injection for treating interstitial ectopic pregnancy is demonstrated.

## Key findings

- Local methotrexate injection led to a significant reduction in β-hCG levels.
- The treatment successfully resolved the interstitial ectopic pregnancy without surgery.

## Abstract

Interstitial ectopic pregnancy is a rare and potentially life‐threatening condition that occurs when a fertilized ovum implants in the interstitial (intramural) portion of the fallopian tube within the myometrium. It accounts for 2%–4% of all ectopic pregnancies and poses significant risks due to the potential for rupture and severe hemorrhage.

We report the case of a 34‐year‐old woman, gravida 5 para 3 + 1, living 4, who presented with right iliac fossa pain at 5 weeks of gestation. Ultrasonography and elevated β‐hCG levels revealed a suspicious interstitial ectopic pregnancy. Initial treatment with systemic methotrexate was administered; however, due to plateauing β‐hCG levels, a second dose of methotrexate was given via direct injection into the ectopic site. Follow‐up monitoring demonstrated a significant reduction in β‐hCG levels, resulting in the successful resolution of the ectopic pregnancy.

This case highlights the successful treatment of interstitial ectopic pregnancy with local methotrexate injection, emphasizing the importance of early diagnosis and timely intervention. Future studies with larger sample sizes and standardized treatment criteria are recommended.