Abstract
Purpose
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.
Similar content being viewed by others
References
Sociedad Española de Ginegología y Obstetricia (2006) Protocolos asistenciales. Obstetricia. Embarazo ectópico. http://www.sego.es. Accessed 26 Sept 2010
Tamarit G, Lonjedo E, González M, Tamarit S, Dominto S, Pellicer A (2010) Combined use of uterine artery embolization and local methotrexate injection in intersticial ectopic pregnancies with poor prognosis. Fertil Steril 93(4):1348.e1–1348.e4
Monteagudo A, Minior VK, Stehenson C, Monda S, Timor-Tritsch E (2005) Non-surgical management of live ectopic pregnancy with ultrasound-guided local injection: a case series. Ultrasound Obstet Gynecol 25:282–288
Canis M, Savaray D, Pouly JL, Wattiez A, Mage G (2003) Ectopic pregnancy: criteria to decide between medical and conservative surgical treatment. J Gyncol Obstet Biol Reprod (Paris) 32(7 Suppl):S54–S63
Tanaka T, Hayashi H, Kutsuzawa T, Fujimoto S, Ichinoe K (1982) Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case. Fertil Steril 37(6):851–852
Kooi S, Kock HC (1990) Treatment of tubal pregnancy by local injection of methotrexate after adrenaline injection into the mesosalpinx: a report of 25 patients. Fertil Steril 54(4):580–584
Fernandez H, Lelaidier C, Doumerc S, Fournet P, Olivennes F, Frydman R (1993) Nonsurgical treatment of heterotopic pregnancy: a report of six cases. Fertil Steril 60:428–432
Darai E, Benifla JL, Naouri M, Pennehouat G, Guglielmina JN, Deval B, Filippini F, Crequat J, Madelenat P (1995) Transvaginal intratubal methotrexate treatment of ectopic pregnancy. Report of 100 cases. Hum Reprod 11(2):420–424
Sand PK, Stubblefield PA, Ory SJ (1986) Methotrexate inhibition of normal trophoblasts in vitro. Am J Obstet Gynecol 155:324–329
Feichtinger W, Kemeter P (1987) Conservative treatment of ectopic pregnancy by transvaginal aspiration under sonographic control and methotrexate injection. Lancet 1:381–382
Ferrara L, Belogolowkin V, Gandhi M, Litton C, Jacobs A, Saltzman D, Rebarber A (2007) Successful management of a consecutive cervical pregnancy by sonographically guided transvaginal local injection. J Ultrasound Med 26:959–965
Hung TH, Shau WY, Hsieh TT, Hsu JJ, Soong YK, Jeng CJ (1998) Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review. Hum Reprod 3(9):2636–2642
Maymon R, Shulman A (1996) Controversies and problems in the current management of tubal pregnancy. Human Reprod Update 2:541–551
Tzafettas J, Anapliotis S, Zournatzi V, Boucklis A, Oxouzoglou N, Bonis J (1994) Transvaginal intra-amniotic injection of methotrexate in early ectopic pregnancy. Advantages over the laparoscopic approach. Early Hum Dev 28:101–107
Hajenius PJ, Mol F, Mol BWJ, Bossuyt PMM, Ankum WM, van der Veen F (2008) Intervenciones para el embarazo ectópico tubárico. Biblioteca Cochrane Plus, Número 4 Oxford: Update software Ltd
Anderson PM, Opfer EK, Busch JM, Magann EF (2009) An early abdominal wall ectopic pregnancy successfully treated with ultrasound guided intralesional methotrexate: a case report. Obstet Gynecol Int 2009:1–3. doi:10.1155/2009/247452
Kirk E, Condous G, Bourne T (2006) The non-surgical management of ectopic pregnancy. Ultrasound Obstet Gynecol 27:91–100
Lipscomb GH, McCord ML, Stovall TG, Huff G, Portera SG, Ling FW (1999) Predictors of success of methotrexate treatment in women with tubal ectopic pregnancies. N Eng J Med 341:1974–1978
Cerveira I, Costa C, Santos F, Santos L, Cabral F (2008) Cervical ectopic pregnancy successfully treated with local methotrexate injection. Fertil Steril 90(5):2005.e7–2005.e10
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Andrés, M.P., Campillos, J.M., Lapresta, M. et al. Management of ectopic pregnancies with poor prognosis through ultrasound guided intrasacular injection of methotrexate, series of 14 cases. Arch Gynecol Obstet 285, 529–533 (2012). https://doi.org/10.1007/s00404-011-2044-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-011-2044-1