Successful management of live ectopic pregnancy with high β-hCG titres by ultrasound-guided potassium chloride injection and systemic methotrexate

Methotrexate (Mtx) is 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. We report a successful management of live ectopic pregnancy in a 27-year-old nulliparous woman, with very high beta-hCG titres (89,200 mIU/mL), using ultrasound-guided intra-sac potassium chloride (KCl) injection and systemic Mtx. Successful resolution of the ectopic pregnancy, with negative serum beta-hCG (< 1 mIU/mL) was achieved after three doses of Mtx, and a prolonged follow-up of 71 days. No treatment related complications were encountered. Concurrent use of intra-sac hypertonic KCl, to produce cardiac asystole, with systemic Mtx could potentially improve outcome in live ectopic gestations with very high serum beta-hCG titres. However, individualised treatment, with a stringent follow-up regime is mandatory in such cases.