{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:41:53Z","timestamp":1792424513847,"version":"4.5.0"},"reference-count":28,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T00:00:00Z","timestamp":1631836800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Interstitial pregnancy is defined as the presence of a gestational sac in the most proximal section of the fallopian tube. Management of interstitial pregnancy remains a debated topic. Depending on hemodynamic stability, size of pregnancy, depth of surrounding myometrium, and desires for future fertility, interstitial pregnancy can be managed medically or surgically. We reviewed the literature in December 2020 using keywords \u201cinterstitial pregnancy\u201d, \u201cmedical treatment\u201d, \u201cmethotrexate\u201d, and \u201cmifepristone\u201d. Articles published from January 1991 until 2020 were obtained from databases EMBASE, SCOPUS, and PUBMED. We describe the case of a patient with an interstitial pregnancy that was managed with a total medical approach in August 2020 at Burlo Garofolo Hospital. The patient was asymptomatic and hemodynamically stable, with a high level of serum \u03b2-hCG (22,272 mUi\/mL). We used the combination of methotrexate (MTX) and mifepristone. Medical therapy was effective leading to interstitial pregnancy resolution in 51 days without collateral effects for the patient. We found seven previous cases reported in the literature. Our purpose is to underline the efficacy of medical therapy with systemic multidose MTX associated with a single oral dose of mifepristone and also folinic acid when is present a viable fetus and a high serum \u03b2-hCG level.<\/jats:p>","DOI":"10.3390\/ijerph18189781","type":"journal-article","created":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T21:23:29Z","timestamp":1631913809000},"page":"9781","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Interstitial Ectopic Pregnancy: The Role of Mifepristone in the Medical Treatment"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9266-3896","authenticated-orcid":false,"given":"Guglielmo","family":"Stabile","sequence":"first","affiliation":[{"name":"Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2157-8330","authenticated-orcid":false,"given":"Federico","family":"Romano","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Zinicola","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghergana Alexandrova","family":"Topouzova","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8845-1206","authenticated-orcid":false,"given":"Giovanni","family":"Di Lorenzo","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Paolo","family":"Mangino","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8031-1102","authenticated-orcid":false,"given":"Giuseppe","family":"Ricci","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health IRCCS \u201cBurlo Garofolo\u201d, 34137 Trieste, Italy"},{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/ajo.12067","article-title":"A conservative and fertility preserving treatment for interstitial ectopic pregnancy","volume":"53","author":"Wright","year":"2013","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s10397-018-1054-4","article-title":"The diagnosis and management of interstitial ectopic pregnancies: A review","volume":"16","author":"Brincat","year":"2019","journal-title":"Gynecol. Surg."},{"key":"ref_3","first-page":"5626783","article-title":"Spontaneous Intraoperative Rupture of a Large Interstitial Pregnancy: Laparoscopic Management","volume":"2020","author":"Koukoura","year":"2020","journal-title":"Case Rep. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"8703496","DOI":"10.1155\/2020\/8703496","article-title":"Conservative Treatment of Interstitial Ectopic Pregnancy with the Combination of Mifepristone and Methotrexate: Our Experience and Review of the Literature","volume":"2020","author":"Stabile","year":"2020","journal-title":"BioMed Res. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ajog.2009.07.054","article-title":"Current diagnosis and treatment of interstitial pregnancy","volume":"202","author":"Moawad","year":"2010","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"312","DOI":"10.4103\/1735-1995.156181","article-title":"Interstitial pregnancy treated with a single-dose of systemic methotrexate: A successful management","volume":"20","author":"Corioni","year":"2015","journal-title":"J. Res. Med. Sci."},{"key":"ref_7","first-page":"1044","article-title":"Sonographic evolution of cornual pregnancies treated without surgery","volume":"79","author":"Monteagudo","year":"1992","journal-title":"Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/uog.4077","article-title":"Catch me if you scan: Ultrasound diagnosis of ectopic pregnancy","volume":"30","author":"Jurkovic","year":"2007","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2038.e5","DOI":"10.1016\/j.fertnstert.2009.08.016","article-title":"Laparoscopic salpingocentesis using methotrexate in combination with oral mifepristone for successful treatment of interstitial pregnancy: A case report","volume":"92","author":"Narang","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"59","DOI":"10.4103\/abr.abr_5_20","article-title":"Which protocol is better for treatment of ectopic pregnancy by methotrexate? Single-dose or multiple-dose","volume":"9","author":"Taghiyar","year":"2020","journal-title":"Adv. Biomed. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.ejogrb.2012.06.024","article-title":"Medical therapy (methotrexate and mifepristone) alone or in combination with another type of therapy for the management of cervical or interstitial ectopic pregnancy","volume":"165","author":"Benitez","year":"2012","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Stabile, G., Zinicola, G., Romano, F., Buonomo, F., Mangino, F.P., and Ricci, G. (2020). Management of Non-Tubal Ectopic Pregnancies: A Single Center Experience. Diagnostics, 10.","DOI":"10.3390\/diagnostics10090652"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1080\/13645706.2018.1547764","article-title":"Laparoscopic reversible occlusion of uterine arteries and cornuostomy for advanced interstitial pregnancy","volume":"28","author":"Garzon","year":"2018","journal-title":"Minim. Invasive Ther. Allied Technol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1093\/humrep\/det459","article-title":"Uterine artery embolization for severe symptomatic fibroids: Effects on fertility and symptoms","volume":"29","author":"Torre","year":"2014","journal-title":"Hum. Reprod."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/S0015-0282(16)46349-1","article-title":"Treatment of interstitial ectopic pregnancy with methotrexate: Report of a successful case","volume":"37","author":"Tanaka","year":"1982","journal-title":"Fertil. Steril."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/GRF.0b013e3182510a73","article-title":"Medical Management of Ectopic Pregnancy","volume":"55","author":"Bachman","year":"2012","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1002\/uog.17329","article-title":"Single-dose systemic methotrexatevsexpectant management for treatment of tubal ectopic pregnancy: A placebo-controlled randomized trial","volume":"49","author":"Jurkovic","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.ijgo.2011.08.009","article-title":"Comparison of double- and single-dose methotrexate protocols for treatment of ectopic pregnancy","volume":"116","author":"Hamed","year":"2011","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_19","unstructured":"Tulandi, T. (2021, June 06). Ectopic Pregnancy: Choosing a Treatment. Up to Date. Available online: https:\/\/www.uptodate.com\/contents\/ectopic-pregnancy-choosing-a-treatment."},{"key":"ref_20","first-page":"778","article-title":"The medical management of ectopic pregnancy: A meta-analysis comparing \u201csingle dose\u201d and \u201cmultidose\u201d regimens","volume":"101","author":"Barnhart","year":"2003","journal-title":"Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.rbmo.2017.01.004","article-title":"Multiple-dose and double-dose versus single-dose administration of methotrexate for the treatment of ectopic pregnancy: A systematic review and meta-analysis","volume":"34","author":"Yang","year":"2017","journal-title":"Reprod. Biomed. Online"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Stabile, G., Mangino, F.P., Romano, F., Zinicola, G., and Ricci, G. (2020). Ectopic Cervical Pregnancy: Treatment Route. Medicina, 56.","DOI":"10.3390\/medicina56060293"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/S0002-9378(98)70057-2","article-title":"Treating ectopic pregnancy with the combination of mifepristone and methotrexate: A phase II nonrandomized study","volume":"179","author":"Perdu","year":"1998","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1345\/aph.10397","article-title":"Mifepristone","volume":"35","author":"DeHart","year":"2001","journal-title":"Ann. Pharmacother."},{"key":"ref_25","unstructured":"Gomez Garc\u00eda, M.T., Del Cerro, E.L., Selva, R.M., Nogueira Garc\u00eda, J., CallejonRodr\u00edguez, C., and Gonzales Merlo, G. (2014). Indications of mifepristone in ectopic pregnancy. Mifepristone: Pharmacology, Medical Uses and Potential Side Effects, Nova Science Publishers."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"34","DOI":"10.3126\/jkmc.v4i1.15028","article-title":"Medical management of unruptured interstitial pregnancy with mifepristone and methotrexate","volume":"4","author":"Karki","year":"2016","journal-title":"J. Kathmandu Med. Coll."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/S0368-2315(04)96546-5","article-title":"Traitement m\u00e9dical des grossesses extra-ut\u00e9rines: Un essai clinique randomis\u00e9 comparant m\u00e9thotrexate-mif\u00e9pristone et placebo-m\u00e9thotrexate","volume":"33","author":"Garbin","year":"2004","journal-title":"J. Gyn\u00e9cologie Obs. Biol. Reprod."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Osada, H., Teramoto, S., Kaijima, H., Segawa, T., Nagaishi, M., Shozu, M., and Kato, K. (2020). Managing Ectopic Pregnancies by Targeting Chorionic Villi with a Transvaginal Injection of Ethanol into the Lacunar Space. Biomedicines, 8.","DOI":"10.3390\/biomedicines8070202"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/18\/9781\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:01:02Z","timestamp":1760166062000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/18\/9781"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,17]]},"references-count":28,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["ijerph18189781"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18189781","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,17]]}}}