Non-surgical management of live ectopic pregnancy with ultrasound-guided local injection: a case series.
OBJECTIVE
To describe a series of consecutive cases of live ectopic pregnancies managed with ultrasound-guided local injection of methotrexate (MTX) or potassium chloride (KCl).


METHODS
Eighteen consecutive women with live and unruptured, tubal, cornual or cervical ectopic pregnancies referred to our unit for evaluation and management underwent risk-benefit counseling. Under transvaginal ultrasound guidance, puncture and injection of the ectopic pregnancy was performed using an automated puncture device. Either MTX or KCl was injected, producing immediate cessation of fetal cardiac activity.


RESULTS
Of the 18 ectopic pregnancies, 10 were cervical, four were tubal and four were cornual. The mean initial beta-hCG level was 33 412 IU and the mean gestational age was 6 + 6 weeks. Ten ectopic gestational sacs were injected with KCl and eight were injected with MTX. There was no difference in time to resolution of the ectopic pregnancies between those injected with KCl and those with MTX.


CONCLUSIONS
Unruptured live ectopic pregnancies of many types can be successfully managed without surgical intervention through local injection of KCl or MTX.
Monteagudo
A
A
Department of Obstetrics and Gynecology, Division of Ob/Gyn Ultrasound, New York University School of Medicine, New York, NY 10016, USA. Ana.Monteagudo@med.nyu.edu
Minior
V K
VK
Stephenson
C
C
Monda
S
S
Timor-Tritsch
I E
IE
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000032:Abortion, Therapeutic / Q000379:methods*; D002584:Cervix Uteri; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D003376:Counseling; D005260:Female; D006801:Humans; D007267:Injections; D008727:Methotrexate / Q000008:administration & dosage*; D011189:Potassium Chloride / Q000008:administration & dosage; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000628:therapy*; D011272:Pregnancy, Multiple; D018570:Risk Assessment; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D011189:Potassium Chloride; D008727:Methotrexate