title: Management of ectopic pregnancies with poor prognosis through ultrasound guided intrasacular injection of methotrexate, series of 14 cases.
abstract: OBJECTIVE
  The purpose of this study is to describe our experience in cases of tubal ectopic pregnancy with heartbeat, abdominal, interstitial (corneal) and cervical ectopic pregnancies treated with intrasacular injection of methotrexate (MTX) administered under ultrasound guidance associated with a single systemic dose of MTX.
  
  
  METHODS
  Descriptive retrospective study of 14 cases of extrauterine pregnancies treated with intrasacular injection of MTX under ultrasound control, attended in the Maternal-Fetal Medicine Unit of the Miguel Servet University Hospital, in Zaragoza, Spain, between January of 2009 and June of 2010.
  
  
  RESULTS
  Of the 14 ectopic pregnancies, 7 were tubal with heartbeat, 3 cornual, 2 cervical and 2 abdominal. The average gestational age was 7 + 3 weeks and the average β-hCG value on the date of puncture was 22,885.69 mIU/mL. Surgical treatment was required in two cases, the first due to post-puncture haemoperitoneum and the second as a consequence of the rupture of the corneal ectopic pregnancy. In post-treatment monitoring, an asymptomatic increase of β-hCG on the seventh day post-puncture was observed in two cases. The success rate of the treatment was 92.96%.
  
  
  CONCLUSIONS
  Ultrasound guided intrasacular injection of MTX associated with a systemic dose adjusted to the body surface of the patient is a minimally invasive, safe and effective treatment in the cases of tubal ectopic pregnancy with heartbeat, abdominal, cornual or cervical ectopic pregnancy.
authors.affiliation: Department of Obstetrics, Miguel Servet University Hospital, C/Monasterio Ntra. Sra. De los Angeles 3, P4, 2ºA, 50012 Zaragoza, Spain.
authors.forename: María P
authors.initials: MP
authors.lastname: Andrés
authors.forename: José M
authors.initials: JM
authors.lastname: Campillos
authors.forename: María
authors.initials: M
authors.lastname: Lapresta
authors.forename: Isabel
authors.initials: I
authors.lastname: Lahoz
authors.forename: Raquel
authors.initials: R
authors.lastname: Crespo
authors.forename: Javier
authors.initials: J
authors.lastname: Tobajas
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D002584:Cervix Uteri; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011269:Pregnancy, Abdominal / Q000097:blood / Q000188:drug therapy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000188:drug therapy*; D011274:Pregnancy, Tubal / Q000097:blood / Q000188:drug therapy; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate