title: Successful management of live ectopic pregnancy with high beta-hCG titres by ultrasound-guided potassium chloride injection and systemic methotrexate.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. vatslad@hotmail.com
authors.forename: Vatsla
authors.initials: V
authors.lastname: Dadhwal
authors.forename: Deepika
authors.initials: D
authors.lastname: Deka
authors.forename: Bhaswati
authors.initials: B
authors.lastname: Ghosh
authors.forename: Suneeta
authors.initials: S
authors.lastname: Mittal
mesh_terms: 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*
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D011189:Potassium Chloride; D008727:Methotrexate