Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Obstet Gynecol. Aug 10, 2015; 4(3): 58-63
Published online Aug 10, 2015. doi: 10.5317/wjog.v4.i3.58
Avoiding misdiagnosing an early intrauterine pregnancy as an ectopic pregnancy
Donald L Fylstra
Donald L Fylstra, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, United States
Author contributions: Fylstra DL solely contributed to this work.
Conflict-of-interest statement: The author has no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Donald L Fylstra, MD, Professor, Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, United States. fylstrad@musc.edu
Telephone: +1-843-7924500 Fax: +1-843-7920533
Received: March 12, 2015
Peer-review started: March 16, 2015
First decision: April 10, 2015
Revised: May 16, 2015
Accepted: July 16, 2015
Article in press: July 18, 2015
Published online: August 10, 2015
Processing time: 159 Days and 10.6 Hours
Abstract

In women at risk for an ectopic pregnancy, every effort should be made to exclude the presence of an intrauterine pregnancy before embarking on an irreversible treatment for ectopic pregnancy. The diagnosis of ectopic pregnancy, unless directly visualized with transvaginal ultrasound, is made with the exclusion of an intrauterine pregnancy. Measurement of human chorionic gonadotrophin and progesterone levels, and transvaginal ultrasound are the tools used to evaluate early pregnancy. In women at risk for an ectopic pregnancy, every effort should be made to exclude the presence of an intrauterine pregnancy before embarking on an irreversible treatment course. Methotrexate is an antimetabolite that inhibits DNA synthesis and repair and cell replication. It is administered to ostensible destroy a pregnancy, especially ectopic pregnancies. When administered to an intrauterine pregnancy, embryonic death and missed abortion is the most common result, but early embryos that survive this exposure are likely to have multiple anomalies. The mistaken administration of methotrexate to an intrauterine pregnancy is made because of misinterpretation of the discriminatory zone of human chorionic gonadotropin (hCG), misinterpretation of early hCG serum levels, misinterpretation of early transvaginal ultrasound images, and failure to clinically correlate hCG levels and ultrasound findings.

Keywords: Ectopic pregnancy; Ultrasound; Human chorionic gonadotropin; Methotrexate

Core tip: In women at risk for an ectopic pregnancy, every effort should be made to exclude the presence of an intrauterine pregnancy before embarking on an irreversible treatment course. Methotrexate is an antimetabolite that inhibits DNA synthesis and repair and cell replication. It is administered to ostensible destroy a pregnancy, especially ectopic pregnancies. When administered to an intrauterine pregnancy, embryonic death and missed abortion is the most common result, but early embryos that survive this exposure are likely to have multiple anomalies.