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.

Keywords: KCl; Live; Methotrexate; Nonsurgical management; Tubal ectopic pregnancy; β-hCG.