Angular pregnancy at 6th week of gestation treated with minimally invasive surgery preceded by systemic and local medical therapy with methotrexate. Case report

Introduction. The angular pregnancy is characterized by the abnormal position of the blastocyst, on the corner of the uterine cavity. It can lead to miscarriage, fetal death or preterm birth, as well as to spontaneous rupture of the uterus due to overdistension. Therefore it requires early diagnosis and careful management. Case report. We present a case of a woman in the sixth week of gestation, with a diagnosis of angular pregnancy, treated with methotrexate, first sistemically and after locally, and then followed by hysteroscopy with resection of the gestational sac. Discussion. Methotrexate promotes the detachment of the trophoblast. The administration of a further dose via intra-amniotic allowed to reduce systemical doses and therefore also the possible side effects. In this way we made hysteroscopic resection of the gestational sac possible and easier, in order to avoid more complicated and invasive interventions. Conclusions. This type of approach has therefore proved to be effective, preserving the uterus from surgical stress and maintaining the possibility of future pregnancies, with excellent compliance by the patient. In any case, we focus attention on the need for early diagnosis, as well as the desire of the mother and the specific characteristics of the clinical case to treat.