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Case Report
Twin tubal and interstitial ectopic pregnancies managed by multidose methotrexate therapy
1 Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
2 Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
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Jessica Shu Nan Li
Department of Obstetrics and Gynaecology, University of Toronto Suite 1200, 123 Edward Street, Toronto, Ontario M5G 1E2,
Canada
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Article ID: 100199Z08JL2025
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Li JSN, Levy R, Wong JMH. Twin tubal and interstitial ectopic pregnancies managed by multidose methotrexate therapy. J Case Rep Images Obstet Gynecol 2025;11(1):53–57.ABSTRACT
Introduction: Twin ectopic pregnancy is a rare diagnosis with no clear consensus guidelines for management. We present a case of a stable patient with a spontaneous twin interstitial and tubal ectopic pregnancy treated with systemic multidose methotrexate.
Case Report: A 31-year-old nulliparous patient was diagnosed with a twin interstitial and tubal ectopic pregnancy after presenting at 6+1 weeks gestational age with a β-hCG of 2303 mIU/mL, vaginal spotting, and mild pain. Given the case characteristics and hemodynamic stability, she was managed with systemic multidose methotrexate and leucovorin rescue. She remained clinically stable and her β-hCG became undetectable on day 42 after treatment initiation.
Conclusion: Multidose methotrexate therapy is a suitable treatment option for carefully selected patients with twin ectopic pregnancies who are hemodynamically stable.
Keywords: Ectopic pregnancy, Interstitial pregnancy, Methotrexate, Tubal pregnancy, Twin ectopic pregnancy
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Author Contributions
Jessica Shu Nan Li - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Romina Levy - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Jeffrey Man Hay Wong - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
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© 2025 Jessica Shu Nan Li 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.
