Successful management of live ectopic pregnancy with high beta-hCG titres by ultrasound-guided potassium chloride injection and systemic methotrexate.
BACKGROUND
Methotrexate (Mtx) is accepted modality for conservative treatment of ectopic pregnancy. However, there is no consensus regarding its use in live ectopic pregnancy and high serum beta-human chorionic gonadotrophin (beta-hCG) titres.


METHODS
We report a successful management of live ectopic pregnancy in a 27-year-old nulliparous woman, with very high beta-hCG titres (89,200 mIU/mL), using ultrasound-guided intra-sac potassium chloride (KCl) injection and systemic Mtx. Successful resolution of the ectopic pregnancy, with negative serum beta-hCG (<1 mIU/mL) was achieved after three doses of Mtx, and a prolonged follow-up of 71 days. No treatment related complications were encountered.


CONCLUSIONS
Concurrent use of intra-sac hypertonic KCl, to produce cardiac asystole, with systemic Mtx could potentially improve outcome in live ectopic gestations with very high serum beta-hCG titres. However, individualised treatment, with a stringent follow-up regime is mandatory in such cases.
Dadhwal
Vatsla
V
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. vatslad@hotmail.com
Deka
Deepika
D
Ghosh
Bhaswati
B
Mittal
Suneeta
S
D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D011189:Potassium Chloride / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood* / Q000188:drug therapy*
D018997:Chorionic Gonadotropin, beta Subunit, Human; D011189:Potassium Chloride; D008727:Methotrexate