Local Ultrasound Guided Intra-Embryonic KCL Instillation with Systemic Methotrexate Versus Methotrexate Alone in Management of Live Tubal Ectopic Pregnancy: A Case Series
Journal Title: Indian Journal of Obstetrics and Gynecology - Year 2017, Vol 5, Issue 1
Abstract
Objective: To compare efficacy of systemic methotrexate with concurrent intra-embryonic potassium chloride (KCl) instillation versus systemic methotrexate alone in cases of live unruptured ectopic pregnancies. Method: In this retrospective comparative study conducted in tertiary care centre; six patients with documented cardiac activity suitable for medical management were given ultrasound-guided intra-embryonic KCl along with systemic methotrexate (Mtx) (Group-1). Their response was compared with six historical cases managed with systemic Mtx alone (Group-2). Results: Medical management was successful in 100% patients in Group-1 treated with combined KCl and Mtx, all responded to only single dose of Mtx. In Group-2, success rate was 83% where 2/6(33.3%) cases were successfully treated with single dose; 3/6(50%) patients responded to 2nd dose of Mtx and 1/6(16.7%) case had rupture. Mean duration for hCG to become negative was 5 weeks (range 3-7 weeks) in Group-1 versus 7.2 weeks (range 4-10 weeks) in Group-2. Conclusion: Live unruptured tubal ectopic pregnancies can be effectively managed with intraembryonic KCl and concurrent systemic Mtx therapy. Addition of KCl alleviates the need for second Mtx dose, minimizes the risk of rupture and results in faster fall of hCG. Patients with high baseline hCG can also be effectively treated with this combined treatment.
Authors and Affiliations
Nutan Agarwal
Keywords
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- EP ID EP456692
- DOI 10.21088/ijog.2321.1636.5117.1
- Views 94
- Downloads 0
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