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

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.