The effect of local aspiration and methotrexate injection on live interstitial pregnancy coexisting with live intrauterine pregnancy after assisted reproductive technology

Abstract

Aim To share the experience of local aspiration and instillation of methotrexate (MTX) to selective reduction of live interstitial pregnancy and to evaluate its clinical effect and the outcome of intrauterine pregnancy. Methods Twelve patients with heterotopic interstitial pregnancy were enrolled at Women's Hospital, Zhejiang University School of Medicine, from 2006 to 2017. All the pregnancies were derived from assisted reproductive technology (ART). The transvaginal aspiration to interstitial pregnancy sac and local instillation of MTX (range from 12.5 to 30 mg) were performed for the patients under ultrasound‐guide. The prognosis and pregnancy outcomes were followed up. Results No severe side effects of medical treatment were observed in all patients. Three cases underwent subsequent laparotomy cornual resection, and no perioperative complications were found in these three patients. Twelve patients gave birth to 13 healthy infants without congenital anomalies. The average birth weight and gestational age was 2837 g (SD ± 605 g) and 36.8 weeks (SD ± 2.4 weeks). No growth anomalies and mental retardation were observed in live birth offspring. Conclusion The transvaginal ultrasound‐guided aspiration and injection of MTX might be a feasible alternative treatment for heterotopic interstitial pregnancy when vital signs of patients are stable.

Management and outcome of heterotopic interstitial pregnancy: Case report and review of literature

“…In 53.6% (15/28) of the patients, 1 mL of 15-20% or 2 mEq potassium chloride (KCl) was administered locally, before or after aspiration of the ectopic pregnancy contents. Alternatively, the local administration of hyperosmolar glucose was described in five cases by Wang et al, 7 and simple aspiration of the gestational products was reported in five cases by Qiong et al 8 In two cases, methotrexate (MTX) was used. The first mentions the aspiration of the ectopic sac, followed by the local instillation of 12.5 mg MTX.…”

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

“…High-risk factors for heterotopic pregnancy (HP) include a history of unilateral or bilateral salpingectomy [ 11 , 13 , 16 , 18 , 23 , 24 , 28 , 29 , 30 ], EP [ 11 , 16 , 18 , 24 , 28 , 29 ], ovulation induction, and IVF-ET [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. Particularly, IVF-ET increases the occurrence of IP [ 33 ].…”

“…Ultrasound interventional therapy refers to ultrasound-guided local drug injection to inactivate the ectopic gestational sac, which is a minimally invasive treatment method that can maximize the integrity of the uterus and reduce the risk of future uterine rupture [ 8 ]. The successful delivery rate of IUP after interventional ultrasound can reach 100% [ 6 ]. Available drugs are KCl [ 7 , 8 , 14 , 21 ] MTX [ 15 , 18 , 29 ] and hypertonic glucose [ 20 ].…”

“…The puncture point was chosen, and the drape was then routinely disinfected. Under the real-time guidance of ultrasound, an 18G puncture needle was advanced to the villus implantation site of the right IP, after which 20 mg of MTX (0.4–0.5 mg/kg body weight was dissolved in 5 mL of normal saline) was slowly injected into the interstitial gestational sac [ 6 ]. The needle was then pulled out after inserting the needle core.…”

The Challenge in Diagnosing and Managing Heterotopic Interstitial Pregnancy in Natural Conception

“…Medical management of the interstitial pregnancy involves aspirating the gestational sac content with or without instillation of feticide agents [17,18]. By opting for medical management, patient must be informed of the lengthy follow-up and risk of rupture of the interstitial pregnancy within the treatment period, in balance with the success rate of more than 90% [19].…”