A case of a methotrexate-resistant ectopic pregnancy in which dactinomycin was effective as a second-line chemotherapy  Satoe Fujioka, M.D., Yoshiki Yamashita, M.D., Sachiko Kawabe, M.D., Hideki Kamegai, M.D., Yoshito Terai, M.D., Masahide Ohmichi, M.D.  Fertility and Sterility  Volume 91, Issue 3, Pages 929.e13-929.e15 (March 2009) DOI: 10.1016/j.fertnstert.2008.10.003 Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 1 Arrow a shows the GS in the uterus, which was later diagnosed as blighted ovum. Arrow b is the GS with the fetus in the interstitial region of the uterus. Fertility and Sterility 2009 91, 929.e13-929.e15DOI: (10.1016/j.fertnstert.2008.10.003) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 2 The urinary hCG level fell to 90 IU/mL from 26,128 IU/mL. But at 25 days after initial administration, the urinary level rose to 172 IU/mL; therefore, dactinomycin at a dose of 12 μg/kg was given to the patient IV. The urinary hCG level fell to less than 10 IU/mL, which indicates no pregnancy. Fertility and Sterility 2009 91, 929.e13-929.e15DOI: (10.1016/j.fertnstert.2008.10.003) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions