Concurrent ultrasound-guided potassium chloride and systemic methotrexate injection in ectopic pregnancies with high B-HCG titers and fetal cardiac activity: Non surgical management of two cases

Methotrexate (MTX) is an accepted regimen for conservative treatment of unruptured ectopic pregnancy. However ,gestational sac greater than 3.5 cm, existence of cardiac activity and high titers of serum beta human chorionic gonadotrophin ( B-HCG) levels are relative contraindications of Mtx treatment. A 29-year-old, gravida 3, parity 1 and a 34-year-old nulliparous women presented with a complaint of secondary amenorrhoea with a B-HCG value of 45,331 and 19.456 mIU/mL, respectively. Transvaginal ultrasonography revealed that an ectopic gestational sac in the adnexa with fetal cardiac activity. We applied ultrasound-guided local potassium chloride injection and single dose systemic MTX Concurrent use of local injection of KCL and systemic MTX could potentially improve outcome in ectopic pregnancies with high serum B-HCG titers and cardiac activity. Unruptured ectopic pregnancies with cardiac activity can be successfully managed with concurrent usage of local KCl injection and systemic MTX without surgical intervention.