Ultrasound management of uncommon ectopic pregnancy

Introduction

With the improvements in ultrasound equipment as well as the easy access to quantitative beta-human chorionic gonadotropin (β-hCG), the timing of diagnosis of ectopic pregnancy has moved to the early part of the first trimester.
Ectopic pregnancies of unusual location are encountered much less frequently, but are perhaps more morbid.
The treatment of these unusual ectopic gestations may not be as common place as treatment of tubal pregnancies, but with early diagnosis and effective planning, their treatment can be equally as effective.

Objective

Describing cases of uncommon ectopic pregnancies which were managed with ultrasound-guided local injection of KCl, followed by intramuscular injection of MTX if appropriate.Explaining the modalities of the conservative treatment and detailing the clinical biological and ultrasound monitoring.

Method

It’s a retrospective study over a period of 3 years which included patients presenting an ectopic pregnancy on uncommon implantation site and whose treatment was conservative.
The medical treatment consisted in injection of KCl in the gestational yak by ultrasound guidance when the pregnancy was scalable.Then we proceed to one or more intramuscular Methotraxate injections in order to complete the treatment.

Results

During the study’s period we collected 04 observations of unusual ectopic pregnancies treated medically.
There was an interstitial pregnancy in 2 cases: a cervical pregnancy in one case and a cesarean scar pregnancy in the other case.
The diagnosis was made by ultrasound in all cases and confirmed by MRI in 2 cases. (Details will be shown in the poster)
The medium term at diagnosis was 6 weeks of amenorrhea.
Pregnancies were evolving with heart activity in 2 cases.
The average number of injection of MTX was 1.3.
In all of our cases, ectopic pregnancies have been successfully managed without surgical intervention or anesthesia using ultrasound-guided puncture and injection of KCl.

Conclusion

The use of advanced ultrasonography in combination with ultrasensitive serum b-hCG assays should lead to early diagnosis of such pregnancies. Early diagnosis and use of multiple modalities can reduce morbidity and mortality in cases of ectopic pregnancy with unusual location and they can be successfully managed without surgical intervention through local injection of KCl.

Keywords

Ectopic, pregnancy

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	Figure 1 İnterstitial pregnancy
	Figure 2 Scar pregnancy