Journal List > Korean J Obstet Gynecol > v.55(11) > 1088551

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Hwang, Lee, Kim, Choi, Shin, and Choi: The successful conservative management of tubal pregnancy with poor prognosis through ultrasound-guided intraamnionic methotrexate injection: Two case reports
Case Report
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2012; 55(11): 848-852.

Published online: 16 November 2012

DOI: https://doi.org/10.5468/KJOG.2012.55.11.848

The successful conservative management of tubal pregnancy with poor prognosis through ultrasound-guided intraamnionic methotrexate injection: Two case reports

Sun Jung Hwang, MD, Soo Jeong Lee, MD, Sul Ah Kim, MD, Jeong In Choi, MD, Jong Chul Shin, MD, Sae Kyung Choi, MD

Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea.

Corresponding author: Sae Kyung Choi, MD. Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-2813, Fax: +82-2-595-1549, obgysk@catholic.ac.kr

Received 1 June 2012       Revised 28 August 2012       Accepted 6 September 2012

Copyright © 2012. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Ectopic pregnancy occurs in about 2% of pregnant women, and may seriously compromise women's health. Extra uterine implantation can occur anywhere along the reproductive tract with the most common implantation site in the fallopian tube. At early stages of presentation where the risk of rupture of a tubal pregnancy is minimal, medical therapy using methotrexate (MTX) given systemically or injected directly into the ectopic pregnancy is an option occasionally used with good results. In addition, ultrasound technology, particularly the introduction of high-resolution transvaginal probes, has been the driving force behind the revolutionary change towards conservative management strategies in ectopic pregnancy care. Tubal pregnancy can be successfully managed without surgical intervention through local injection of MTX. This treatment not only ablates the ectopic pregnancy but also preserves the salpinx without systemic side effect. In this report, we present two cases of tubal pregnancy which treated successfully with ultrasound-guided intraamnionic MTX injection.

Keywords: Ectopic pregnancy, Methotrexate, Interventional ultrasound

Figures and Tables

Fig. 1
Doppler ultrasound-guided intraamnionic methotrexate injection was done arrows.
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Fig. 2
Transvaginal sonogram shows tubal pregnancy containing embryo before methotrexate injection (A) and collapased G-sac after the procedure (B).
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Fig. 3
Comparison of serial serum beta-human chorionic gonadotropin concentration between salpingectomy, systemic methotrexate (MTX), and case 1, 2.
kjog-55-848-g003

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