This was a pilot study comparing the success between early versus late external cephalic version (ECV) involving primigravidae with singleton breech pregnancy. They were randomised into early (34–36 weeks) and late (37-40 weeks) ECV groups. A total of 44 women were initially randomised into 22 women for each group. The overall ECV success rate was acceptable in both groups although insignificantly higher in the late ECV group (55.6% versus 46.7%, p= 0.732.) Caesarean
section in the early ECV group was higher (80% versus 72.2%). Early ECV group had women with higher BMI (29.5 versus 26.8 kg/m2, p=0.107), anterior placentation (60% versus 38.9%) and extended breech presentation (55.6% versus 44.4%; p= 0.296). In conclusion, early ECV in primigravidae showed no better success rate than late ECV. Maternal obesity, anterior placentation and extended breech presentation should alert to failure risk.
Ectopic pregnancy in the interstitial part of the fallopian tube (cornual pregnancy) is a rare condition but can be fatal. Traditionally, the treatment had been cornual resection or hysterectomy. More conservative approaches had been advocated recently. There is no consensus on the dose or number of methotrexate injections that should be used in the treatment of interstitial pregnancies. Single dose intramuscular methotrexate is one of the treatment options. However, the failure rate is higher if the serum beta-hCG (beta-human chorionic gonadotrophin) level is more than 5000 IU/L. We report a case of cornual ectopic pregnancy with high initial serum beta-hCG level being successfully treated with multiple doses of systemic methotrexate. MRI was used to assess clinical resolution of cornual ectopic pregnancy.