EDITORIAL COMMENT: We accepted this paper for publication not only because of its rare anecdotal interest but also because it seems to us that if ever an ectopic pregnancy warrants management with direct injection of methotrexate it is when it is attached to areas such as described in this paper where horrendous haemorrhage or damage to the biliary tract could occur as mentioned in the cases reviewed from the literature.
Summary: An ectopic pregnancy of the liver posterior to the porta hepatis and therefore in a surgically hazardous area was successfully treated with injection of methotrexate at laparotomy.
The results of this study suggest that adding induction and augmentation of labor, together with low pelvic instrumental delivery, to the treatment options in a low-intervention unit would raise the rate of successful confinement within the unit from 55% to 82%. Our scoring system now requires prospective evaluation to further assess its clinical value.
EDITORIAL COMMEN'R We accepted this case for publication to allow readers to see the point that a morbidly adherent placenta in the cervix and/or Iower uterinesegment can lead to catastrophic haemorrhage whether the fetus .%above the abnormally implanted placenta (most cases of placenta accreta, increta or percreta) or below it (most cases of Cervicalprqnancy which can also be asociated with placenta accreta, increta or percwa). The mom1 of the stov seems to be that conservative treatment with methotrexate or balloon tamponade requires diagnos& before damage to the cervix or loweruterine segment occtlls due to attempted or actual removal of the placenta. However there are reports of cam of cervical pregnancy where very considemble haemorrhage was quickly controlled by a large Foley catheter or Sengstaken-Blakemore tube, usually when the pfacenta had been removed. 1. Registrar. 2. Senior Lecturer.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.