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Case Report
Medical management of hepatic ectopic pregnancy with systemic methotrexate, MRI and serial HCG monitoring
1 MD, MSPH, Clinical Fellow in the Division of Complex Family Planning, Department of Obstetrics & Gynecology, OHSU, Portland, OR, USA
2 MD, MPH, Resident Physician, Department of Obstetrics & Gynecology, OHSU, Portland, OR, USA
3 BS, School of Medicine, OHSU, Portland, OR, USA
4 MD, MCR, Assistant Professor & Complex Family Planning Clinical Lead, Department of Obstetrics & Gynecology, OHSU, Portland, OR, USA
Address correspondence to:
Abigail Liberty
MD, MSPH, Kohler Pavilion, 808 SW Campus Dr., Portland, OR 97239,
USA
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Article ID: 100134Z08AL2023
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How to cite this article
Liberty A, Nacev E, Doshi U, Colwill A. Medical management of hepatic ectopic pregnancy with systemic methotrexate, MRI and serial HCG monitoring. J Case Rep Images Obstet Gynecol 2023;9(1):1–6.ABSTRACT
Introduction: Hepatic ectopic pregnancies remain a diagnostic challenge which contributes to high morbidity. Little is known about the efficacy of medical management of hepatic ectopic pregnancies. As early pregnancy diagnosis continues to improve, more abdominal ectopic pregnancies will be identified before a complication occurs and patients may be candidates for less invasive management approaches.
Case Report: A reproductive age G2P0010 presented with pleuritic RUQ pain and was ultimately diagnosed with a hepatic ectopic pregnancy. Given the location of the pregnancy and the difficulty accessing it from both an interventional radiology and surgical perspective, inpatient medical management with methotrexate was pursued. A multidisciplinary team including gynecology, interventional radiology, hepatobiliary surgery, and trauma surgery all participated in perioperative planning in case of an acute deterioration. The patient remained hemodynamically stable and exhibited an appropriate response to methotrexate therapy using the multi-dose regimen. Persistent radiographic changes were still evident in the liver six months later despite resolution of the human chorionic gonadotropic (HCG) values.
Conclusion: This case represents a conservative approach to a complex diagnosis and should inform future clinicians expeditious administration of methotrexate therapy and careful consideration of interval imaging for treatment response.
Keywords: Abnormal pregnancy, Ectopic pregnancy, Methotrexate therapy
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Author Contributions
Abigail Liberty - Conception of the work, Design of the work, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Erin Nacev - Acquisition of data, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Uma Doshi - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Alyssa Colwill - Conception of the work, Design of the work, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Abigail Liberty et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
