Successful management of heterotopic pregnancy after fetal reduction using potassium chloride and methotrexate

Deka, Deepika; Bahadur, Anupama; Singh, Aprajita; Malhotra, Neena

doi:10.4103/0974-1208.97807

Cited by 26 publications

(4 citation statements)

References 17 publications

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“…Medical treatment would provide an effective choice for these patients [ 19 ]. It consisted of suction aspiration or a combination with injections of MTX, KCL in the gestational sac or fetal heart [ 20 ]. The use of MTX was contraindicated previously because of its potential embryotoxicity on the IUP but recent studies have proved its safety and effectiveness with local injection of low-dose [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of 50 patients with heterotopic pregnancy after ovulation induction or embryo transfer

Zhang

et al. 2018

Eur J Med Res

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ObjectivesThe purpose of this study was to evaluate the clinical characteristics, prenatal diagnosis, and management of patients with heterotopic pregnancy after ovulation induction or embryo transfer.MethodsThis was a retrospective study of fifty cases with heterotopic pregnancy, in which the fertilization way, type and number of embryo transferred, gestational age, clinical presentation and outcome of intrauterine, ultrasound presentation and site of ectopic pregnancy, bilateral fallopian tube and treatment were evaluated.ResultsSix patients had spontaneous pregnancy and two had artificial insemination after ovulation induction. Sixteen had fresh and nineteen had frozen embryo transfer with seven patients unrecorded its embryo type and number. The average days from transplantation (or intercourse/insemination) to diagnosing heterotopic pregnancy was thirty-seven with the earliest eighteen and the latest more than 70 days. Although the most common presentation was vaginal bleeding or abdominal pain, more than 21% was found by ultrasound and rare individuals even presented with gastrointestinal symptom which may imply ruptured EP and hemorrhagic shock. Giving proper treatment (surgery or local drug injection), the majority of them had a successful intrauterine pregnancy with only seven miscarried.ConclusionsOvulation induction or embryo transfer increased the risk of HP greatly and clinician should raise high suspicious during the whole first trimester. Although the most ectopic site was ampullary, other sites such as cornual, cervical, abdominal especially interstitial or tubal stumps should also be assessed by ultrasound even in patients with bilateral salpingectomy or tubal obstructed. Repeated ultrasound tests 2 weeks after the diagnosis of intrauterine pregnancy with heart beating was very necessary to find the missed ones in suspicious patients. Compared with surgery, embryo suction with or without proper local drug injection would be more advisable for patients with cervical, cornual, or interstitial pregnancy in order to reserve the intrauterine pregnancy.

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Section: Discussionmentioning

confidence: 99%

Clinical analysis of 50 patients with heterotopic pregnancy after ovulation induction or embryo transfer

Zhang

et al. 2018

Eur J Med Res

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“… 22 But evidence of MTX-related teratogenicity has already been observed in surviving intrauterine fetus after failed medical abortion or other treatment. 23 , 24 Though there are researches showed good therapeutic effect and no negative pregnancy outcomes with medical treatment of MTX, 7 , 16 , 25 , 26 ; we hold the attitude that the use of MTX, no matter systematically or locally, should be avoided in the treatment of HP.…”

Section: Discussionmentioning

confidence: 98%

Management of Heterotopic Pregnancy

Kong²,

Yang³

et al. 2016

Medicine

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The objective of this study is to summarize the experiences of our department in the management of heterotopic pregnancy (HP) and to analyze the influence of different treatment modality on the viable intrauterine pregnancy.There were 64 patients diagnosed as HP in the Department of Gynecology and Obstetrics in our hospital between January 2003 and June 2014, 52 HP patients with viable intrauterine pregnancy were included and analyzed in our study. Interventions included expectant management, surgical management and transabdominal sonographic guided transvaginal aspiration of ectopic gestational embryo (embryo aspiration) management.Main outcome measures are maternal outcome and pregnancy outcome.In expectant management group, 4 patients suffered rupture of ectopic pregnancy, 6 patients transferred to surgical management, 1 patient suffered a fever of 40.4°C, the abortion rate was 5% (1/20). In surgical management group, emergency surgery was performed in 9 patients with unstable hemodynamics and 3 patients with stable hemodynamics, 1 patient suffered uterine rupture 5 weeks later and dead fetus was demonstrated, 1 patient suffered urinary retention postoperative, the abortion rate was 14.8% (4/27). In embryo aspiration management group, 1 patient needed another embryo aspiration, all patients were eventful and no abortion was observed.In our retrospective study, transabdominal sonographic guided aspiration of ectopic gestational embryo has the best maternal outcome and the lowest abortion rate, surgical management group shows the highest abortion rate, and expectant management presents the worst maternal outcome.

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“…The use of surgery via laparoscopy [ 5 – 7 ] and laparotomy [ 4 , 5 , 8 ] has been described as above. Administration of methotrexate and/or intracardiac potassium chloride has also been described in the past for treatment of abdominal pregnancies [ 6 , 10 – 13 ]. Not all of the prior reported cases of pregnancies in the uterosacral ligament trended beta-hCG levels [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Case of Ruptured Ectopic Pregnancy in the Uterosacral Ligament and Review of the Literature

Abedin

Chadha

2020

Case Reports in Obstetrics and Gynecology

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Pregnancies that implant on the uterosacral ligament are rare. Here, we describe a case of ruptured ectopic pregnancy in the left uterosacral ligament in a patient with potential risk factors including possible endometriosis and recent hysteroscopic procedure. A 29-year-old female, para 0, presented to the emergency department with generalized abdominal pain. Pelvic examination was significant for fullness in the posterior cul-de-sac. Laboratory values were significant for beta-human chorionic gonadotropin (hCG) level of 6311 mIU/mL. Sonogram findings were significant for no intrauterine gestation, a 6.9×4.6×4.7 cm3 complex left adnexal mass, and moderate free fluid within the posterior cul-de-sac. The patient underwent laparoscopy, which revealed hemoperitoneum and unremarkable bilateral fallopian tubes and ovaries. An abnormal area was noted in the left uterosacral ligament. Tissue was bluntly removed and pathologically confirmed as chorionic villi within the left uterosacral ligament. After one week, her beta-hCG decreased to 784 mIU/mL. After two weeks, she was seen as an outpatient and was doing well without any symptoms. More information is required regarding these unique pregnancies to help understand the pathophysiology and determine the management.

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Successful management of heterotopic pregnancy after fetal reduction using potassium chloride and methotrexate

Cited by 26 publications

References 17 publications

Clinical analysis of 50 patients with heterotopic pregnancy after ovulation induction or embryo transfer

Clinical analysis of 50 patients with heterotopic pregnancy after ovulation induction or embryo transfer

Management of Heterotopic Pregnancy

Case of Ruptured Ectopic Pregnancy in the Uterosacral Ligament and Review of the Literature

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