title: Conservative management of live tubal pregnancies by ultrasound guided potassium chloride injection and systemic methotrexate treatment.
abstract: Unruptured live tubal ectopic pregnancies are often managed surgically. Significantly elevated beta-hCG levels in these patients make treatment with methotrexate ineffective. However, achieving cardiac asystole via sonographically guided injection of potassium chloride (KCl) along with systemic methotrexate can improve treatment outcome. We describe the successful conservative management of 3 cases of unruptured tubal pregnancy with cardiac activity and significantly elevated beta-hCG levels. Under sonographic guidance, KCl was injected into the fetal heart to achieve cardiac asystole, and patients concurrently received a systemic methotrexate injection. The resolution of ectopic pregnancy was achieved and surgery was avoided in all 3 cases. Conservative management may thus be an option for patients with live ectopic pregnancies.
authors.affiliation: Department of Obstetrics and Gynecology (D-50), University of Miami School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
authors.forename: Usha
authors.initials: U
authors.lastname: Verma
authors.forename: Elvire
authors.initials: E
authors.lastname: Jacques
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000032:Abortion, Therapeutic / Q000379:methods*; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D005318:Fetal Heart; D006323:Heart Arrest / Q000139:chemically induced; D006801:Humans; D007267:Injections; D008727:Methotrexate / Q000008:administration & dosage*; D011189:Potassium Chloride / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging* / Q000628:therapy; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D011189:Potassium Chloride; D008727:Methotrexate