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Sonographically Guided Minimally Invasive Treatment of Unusual Ectopic Pregnancies

Departments of Radiology (P.M.D., C.B.B., M.C.F.) and Obstetrics and Gynecology (E.G.), Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts USA.

Address correspondence and reprint requests to Peter M. Doubilet, MD, PhD, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 USA. E-mail: pdoubilet{at}partners.org.

Objective. To present our experience with sonographically guided treatment of unusual ectopic pregnancies, defined as heterotopic pregnancies and pregnancies occurring at ectopic locations other than the extracornual portion of the fallopian tube. Methods. We retrieved and reviewed all cases of unusual ectopic pregnancies that underwent sonographically guided therapy at our institution. Twenty-seven cases were identified, from 1992 through 2003, including 18 cervical, 6 cornual, 1 tubal heterotopic, and 2 cesarean scar implantations. Results. All of the cervical ectopic, cornual ectopic, and tubal heterotopic pregnancies were treated by sonographically guided injection of potassium chloride into the ectopic gestational sac or fetus. Guidance was via transvaginal sonography in all 18 cervical pregnancies, 3 of the 6 cornual pregnancies, and the tubal heterotopic pregnancy, and via transabdominal sonography in 3 cornual ectopic pregnancies. One of the cesarean scar pregnancies was treated by transvaginally guided potassium chloride injection, and the other was treated via transabdominally guided dilation and evacuation. Treatment was successful in 25 of the 27 patients, including all 23 patients with an ectopic pregnancy and no concomitant intrauterine pregnancy. Four patients had concomitant intrauterine and ectopic pregnancies (1 cervical, 2 cornual, and 1 tubal); in 3 the intrauterine fetuses resulted in live-born infants, and in the fourth the intrauterine pregnancy was electively terminated. Eight of the 27 patients had subsequent intrauterine pregnancies. Conclusions. Sonographically guided minimally invasive treatments of unusual ectopic pregnancies are safe and effective alternatives to surgical and systemic medical therapy. These treatments ablate the ectopic pregnancy, permit normal continuation of a concomitant intrauterine pregnancy, and preserve the uterus for subsequent pregnancies.

Key Words: cervix • cornu • ectopic pregnancy • treatment

Abbreviations: D&E, dilation and evacuation • hCG, human chorionic gonadotropin • IVF, in vitro fertilization • KCl, potassium chloride

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