Korean J Obstet Gynecol.  2012 Nov;55(11):848-852. 10.5468/KJOG.2012.55.11.848.

The successful conservative management of tubal pregnancy with poor prognosis through ultrasound-guided intraamnionic methotrexate injection: Two case reports

• Hwang SJ
• Lee SJ
• Kim SA
• Choi JI
• Shin JC
• Choi SK

• KMID: 2274155
• DOI: http://doi.org/10.5468/KJOG.2012.55.11.848

Abstract

Ectopic pregnancy occurs in about 2% of pregnant women, and may seriously compromise women's health. Extra uterine implantation can occur anywhere along the reproductive tract with the most common implantation site in the fallopian tube. At early stages of presentation where the risk of rupture of a tubal pregnancy is minimal, medical therapy using methotrexate (MTX) given systemically or injected directly into the ectopic pregnancy is an option occasionally used with good results. In addition, ultrasound technology, particularly the introduction of high-resolution transvaginal probes, has been the driving force behind the revolutionary change towards conservative management strategies in ectopic pregnancy care. Tubal pregnancy can be successfully managed without surgical intervention through local injection of MTX. This treatment not only ablates the ectopic pregnancy but also preserves the salpinx without systemic side effect. In this report, we present two cases of tubal pregnancy which treated successfully with ultrasound-guided intraamnionic MTX injection.

Keyword

Ectopic pregnancy; Methotrexate; Interventional ultrasound

MeSH Terms

Fallopian Tubes
Female
Humans
Methotrexate
Pregnancy
Pregnancy, Ectopic
Pregnancy, Tubal
Pregnant Women
Prognosis
Rupture
Ultrasonography, Interventional
Women's Health
Methotrexate

Figure

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  Fig. 1 Doppler ultrasound-guided intraamnionic methotrexate injection was done arrows.

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  Fig. 2 Transvaginal sonogram shows tubal pregnancy containing embryo before methotrexate injection (A) and collapased G-sac after the procedure (B).

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  Fig. 3 Comparison of serial serum beta-human chorionic gonadotropin concentration between salpingectomy, systemic methotrexate (MTX), and case 1, 2.

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