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When Methotrexate Is Not Enough: Hysteroscopic Management of an Angular Pregnancy With Discordant Beta-Human Chorionic Gonadotropin (b-hCG) and Ultrasound Findings

Year: 2026

Type: article

Abstract: An angular pregnancy is a rare form of ectopic implantation. We report a 30-year-old primigravida presenting with an abnormal beta-human chorionic gonadotropin (b-hCG) trend. At presentation, her b-hCG was 1,950 mIU/mL. Ultrasound showed an angular gestational sac with increased vascularization and deep myometrial extension. Methotrexate was administered, achieving biochemical response but with persistent suspicious ultrasound findings, suggesting ongoing trophoblastic activity. Due to this discordance, hysteroscopic management was performed. The gestational tissue was exposed and removed using a bipolar mini-resectoscope under direct visualization. The patient was discharged the same day. Hysteroscopy may represent a safe and effective option in selected cases with discordant biochemical and imaging findings.

Source: Cureus

DOI: 10.7759/cureus.107054

Authors: Francesco Pio Toscano, Virginia Gargano, Lucio Cipullo, Roberta Gallo, Raffaella Del Papato, Giuseppe Laurelli

Institutions: AOU San Giovanni di Dio e Ruggi d'Aragona, University of Naples Federico II

Language: English

Topic: Ectopic Pregnancy Diagnosis and Management

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7154334526