Transabdominal Ultrasound-guided Intra-gestational Sac Single Dose MTX Injection in a Tubal Pregnancy

Abstract

536 A 32-year-old woman, G3P0, was referred to our emergency department from a local medical clinic. She had missed her period for 4 weeks, and did not have any vaginal bleeding. She had mild lower abdominal tenderness on the right side. Transabdominal ultrasound showed an adnexal mass with fetal heart activity. The crown-rump length of the embryo was 1.73 cm (Figures 1A and 1B) and there was no intrauterine sac. The endometrium was 1.05 cm with an anteverted uterus (Figure 1C). There was no fluid in the cul-de-sac or pelvic cavity. The serum β-hCG level was 84,304 mIU/mL. The hemoglobin level was 12.9 g/dL and vital signs were stable. The patient was given different management options for ectopic pregnancy including surgical and medical treatment, and possible related risk factors. She expected to receive medical treatment for her fertility plan. Under transabdominal ultrasound with a puncturing device, a 22-gauge needle was inserted into the ectopic gestational sac, and a 50 mg (2 mL) methotrexate (MTX) solution was injected into the fetal thorax (Figure 2). Cardiac activity of the embryo immediately ceased. There was no internal bleeding or lower abdominal cramping pain after the injection. The patient was admitted to our ward for monitoring of vital signs and was discharged 2 days later uneventfully. In the outpatient clinic follow-up, her serum β-hCG levels declined to 71,755 mIU/mL on the fourth day after injection, and dropped to half the initial levels on the 10th day of treatment, and then became negative on the 53rd day after injection. TRANSABDOMINAL ULTRASOUND-GUIDED INTRA-GESTATIONAL SAC SINGLE DOSE MTX INJECTION IN A TUBAL PREGNANCY