{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T11:24:47Z","timestamp":1761218687546,"version":"3.41.2"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,8,18]],"date-time":"2024-08-18T00:00:00Z","timestamp":1723939200000},"content-version":"vor","delay-in-days":230,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Obstetrics and Gynecology"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>The incidence of unilateral tubal twin pregnancy is 1\/20,000\u20131\/250,000 with about 100 reported cases. Four of the six cases that were medically managed were successful. A 24\u2010year\u2010old female presented to the emergency department (ED) with vaginal bleeding and abdominal cramping. She was hemodynamically stable without signs of an acute abdomen. Laboratory evaluation revealed she was pregnant with a serum beta\u2010human chorionic gonadotropin (b\u2010hCG) of 798\u2009mIU\/mL. Transvaginal ultrasound (TVUS) revealed a single left tubal pregnancy with a yolk sac. The patient elected medical management with body surface area (BSA)\u2013based intramuscular (IM) methotrexate (MTX). On Day 4, the patient returned to the ED; her b\u2010hCG was 727\u2009mIU\/mL. TVUS revealed twin left tubal pregnancies with yolk sacs and fetal poles without cardiac activity. The patient elected to continue medical management with a second dose of BSA\u2010based IM MTX. On Day 6, the patient returned to the ED with abdominal and rectal pain. She was hemodynamically stable without signs of an acute abdomen. Her b\u2010hCG was 533\u2009mIU\/mL. TVUS showed persistent twin left tubal pregnancies\u2014one at 5 weeks gestational age and the other at 6 weeks gestational age\u2014without evidence of rupture. The patient continued serial b\u2010hCGs. Thirty\u2010one days after the first dose of MTX, her b\u2010hCG was &lt;\u20091\u2009mIU\/mL. TVUS showed resolution of tubal pregnancies. The patient consented to the publication of this case report. This case documents the successful treatment of spontaneous, unilateral tubal twin pregnancies with two\u2010step dosing of IM MTX.<\/jats:p>","DOI":"10.1155\/2024\/5543780","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T06:03:50Z","timestamp":1724047430000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Successful Management of Spontaneous Unilateral Twin Ectopic Pregnancy With Two\u2010Step Dose of Methotrexate"],"prefix":"10.1155","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2493-4468","authenticated-orcid":false,"given":"Lauren A.","family":"Forbes","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Navya","family":"Nuthivana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6863-4411","authenticated-orcid":false,"given":"Renee","family":"Morales","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,8,18]]},"reference":[{"key":"e_1_2_9_1_2","doi-asserted-by":"publisher","DOI":"10.23750\/abm.v89i3.6915"},{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deg344"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2022.2136747"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)02478-3"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2022.10.019"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.04.038"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina57050411"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0b013e3182510a88"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2005.11.055"},{"key":"e_1_2_9_10_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1993.03050357.x"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(97)70109-1"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2008.03.012"},{"key":"e_1_2_9_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-010-1449-6"},{"key":"e_1_2_9_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000012343"},{"key":"e_1_2_9_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002560"},{"key":"e_1_2_9_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina58070937"},{"key":"e_1_2_9_17_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0152343"},{"key":"e_1_2_9_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2012.06.041"},{"key":"e_1_2_9_19_2","doi-asserted-by":"publisher","DOI":"10.1159\/000073774"},{"key":"e_1_2_9_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200304000-00028"},{"key":"e_1_2_9_21_2","doi-asserted-by":"publisher","DOI":"10.3109\/00016349.2010.486825"},{"key":"e_1_2_9_22_2","doi-asserted-by":"publisher","DOI":"10.3109\/00016349609033276"}],"container-title":["Case Reports in Obstetrics and Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/2024\/5543780","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T06:03:54Z","timestamp":1724047434000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/2024\/5543780"}},"subtitle":[],"editor":[{"given":"Manvinder","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1155\/2024\/5543780"],"URL":"https:\/\/doi.org\/10.1155\/2024\/5543780","archive":["Portico"],"relation":{},"ISSN":["2090-6684","2090-6692"],"issn-type":[{"type":"print","value":"2090-6684"},{"type":"electronic","value":"2090-6692"}],"subject":[],"published":{"date-parts":[[2024,1]]},"assertion":[{"value":"2023-04-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"5543780"}}