Raana Kanwal, Atif Rana, Shazia Fakhar, Muhammed Shozab.
Exclusive Intrasac Methotrexate and Intracardiac Potassium Chloride Administration for Treatment of Viable Scar Pregnancy - a Case Report.
Pak J Radiol May ;30(4):289-92.

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 treatment. Interventional radiology has changed the fate of ectopic pregnancy. With transvaginal sonography; early diagnosis and treatment is made possible, consequently allowing preservation of uterus and fertility. Intrauterine administration of methotrexate (MTX) is a conservative and non-surgical method for ectopic pregnancy cessation. METHOD AND MATERIAL We`re describing two cases of live ectopic pregnancy with transvaginal ultrasound-guided local injection of methotrexate (MTX) complemented with potassium chloride (KCl). A 36 years old woman with 4 previous Caesarean scars, live and unruptured uterine ectopic scar pregnancy was referred to interventional radiology unit for evaluation and management. She underwent risk-benefit counseling. Under transvaginal sonographical guidance, puncture and injection of the ectopic pregnancy was performed using a 22G Chiba device. Intrasacular MTX was injected, which was complemented with fetal intracardiac administration of KCl, producing immediate cessation of fetal cardiac activity. Patient was followed up after a week revealing reduction in size of remaining gestational sac with decrease in beta hcg. Reporting another case of 34 years old woman with ectopic pregnancy at site of incision of lower segment uterine scar pregnancy of approximately 5 weeks and 5 days. Transducer guided fashioned from the sterile covering of 22 G hiba needle advanced through the guide into gestational sac, approximately 1 ml of KCl was injected slowly. Afterwards 25 mg (1 ml) MTX was injected into the gestational sac. RESULT: Immediate cessation of fetal cardiac activity was noted. Weekly follow-up ultrasound remained uneventful with progressive resolution of gestational sac remnant. CONCLUSION: We conclude that unruptured live ectopic pregnancy can be successfully managed without surgical intervention through local injection of KCl and MTX. This approach may be considered as first line minimally invasive management option in patients desirous of further fertility. Nevertheless, accumulation of further cases is required to validate this modality.

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