Successful Management of Tubal Ectopic Pregnancy with Transvaginal Sonography Guided Intracardiac KCL Injection and Systemic Methotrexate - A Case Report

Background; Methotrexate (Mtx) is an accepted modality for conservative treatment of ectopic pregnancy. However, there is no consensus regarding its use in live ectopic pregnancy and high serum beta-human chorionic gonadotrophin (beta-hCG) titres. Concurrent use of intra-sac hypertonic KCl, to produce cardiac asystole with systemic Mtx potentially improve outcome in live ectopic gestations with very high serum beta-hCG titres. Here a successful management of live ectopic pregnancy in a 25-year-old nulliparous woman, with very high beta-hCG titres (29502.04mIU/mL), using ultrasound-guided intra-cardiac potassium chloride (KCl) injection and systemic Mtx is reported. No treatment related complications were encountered. However, individualized treatment with a stringent follow-up regime is mandatory in such cases.