Transvaginal Ultrasound-Guided Methotrexate and Potassium Chloride Administration for Scar Pregnancy, a Novel Treatment Option: A Case Series

Abstract

Background: Cesarean scar pregnancy is a rare type of ectopic pregnancy, which is potentially life-threatening if not diagnosed and treated timely, resulting in catastrophic complications. Early diagnosis is critical for the treatment. Transvaginal sonography has made possible early diagnosis and consequently preservation of the uterus and fertility. Intrauterine administration of methotrexate (MTX) is a conservative and nonsurgical method for ectopic pregnancy cessation. Methods: We describe two cases of live ectopic pregnancies managed with ultrasoundguided local injection of MTX complemented with potassium chloride (KCl). A 36-year-old woman with four previous cesarean scars, live and unruptured uterine ectopic scar pregnancy was referred to the Interventional Radiology Unit for evaluation and management. She underwent risk-benefit counseling. Under transvaginal sonographical guidance, puncture and injection of ectopic pregnancy was performed using a 22G Chiba device. Intrasacular MTX was injected, which was complemented with fetal intracardiac administration of KCl. We report another case of 34-year-old woman with 6 weeks ectopic pregnancy at the site of incision of lower-segment uterine scar pregnancy. Transducer guided 22G Chiba needle was advanced through the guide into gestational sac, approximately 1 ml of KCl was injected slowly. Afterward, 25 mg (1 ml) MTX was injected into the gestational sac. Results: Immediate cessation of fetal cardiac activity was noted. Weekly follow-up ultrasounds for a month remained uneventful with progressive resolution of gestational sac remnant. Conclusion: Unruptured live ectopic pregnancy can be successfully managed without surgical intervention through local injection of KCl and MTX preserving uterus.