Nonsurgical management of live tubal ectopic pregnancy by ultrasound-guided local injection and systemic methotrexate.

Abstract

STUDY OBJECTIVE:

To evaluate outcomes relative to treatment using systemic methotrexate (MTX) alone or systemic MTX combined with ultrasound (US)-guided local injection of potassium chloride (KCl) or MTX in women with live tubal ectopic pregnancies.

DESIGN:

Case-control study (Canadian Task Force classification II-2).

SETTING:

Departments of Obstetrics and Gynecology in 2 hospitals in China.

PATIENTS:

Eighty-two women with live tubal ectopic pregnancies.

INTERVENTION:

Participants in the study received treatment using either systemic MTX (n = 37; systemic treatment group) or systemic MTX and US-guided local injection of either MTX or KCl (n = 45; combined treatment group).

MEASUREMENTS AND MAIN RESULTS:

Patient clinical features and outcomes were compared. There were no significant differences between the patient groups insofar as baseline gestational age, β-human chorionic gonadotropin concentration, or size of conceptus. The success rate in patients who received combined therapy (93.3%) was much higher than in those who received only systemic treatment (73.0%) (p < .05). In the combined treatment group, the success rate was similar between women who received locally injected KCl (95.2%) and those who received locally injected MTX (91.7%).

CONCLUSION:

The significantly higher success rate in patients who received combined US-guided local injection and systemic MTX suggests that this is an efficient nonsurgical option in women with tubal pregnancy, high serum β-human chorionic gonadotropin concentration, and fetal cardiac activity.

• Authors: Mingyi Wang, Biliang Chen, Jian Wang, Xiangdong Ma, Yu Wang
• Journal: Journal of minimally invasive gynecology (J Minim Invasive Gynecol) 2014 Jul-Aug Vol. 21 Issue 4 Pg. 642-9 ISSN: 1553-4669 [Electronic] United States
• PMID: 24462855 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Chemical References

• Abortifacient Agents, Nonsteroidal
• Potassium Chloride
• Methotrexate

Topics

• Abortifacient Agents, Nonsteroidal (therapeutic use)
• Adult
• Case-Control Studies
• China
• Female
• Gestational Age
• Humans
• Injections
• Methotrexate (therapeutic use)
• Potassium Chloride (therapeutic use)
• Pregnancy
• Pregnancy, Tubal (drug therapy)
• Treatment Outcome
• Ultrasonography, Interventional (methods)
• Young Adult