Non-surgical management of live ectopic pregnancy with ultrasound-guided local injection: a case series

Objectives To describe a series of consecutive cases of live ectopic pregnancies managed with ultrasound-guide 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. Copyright (c) 2005 ISUOG. Published by John Wiley C Sons, Ltd.