Background: Cesarean scar pregnancy is a rare type of ectopic pregnancy, which is potentially
life-threatening if not diagnosed and treated timely, resulting in catastrophic complications.
Early diagnosis is critical for the treatment. Transvaginal sonography has made possible
early diagnosis and consequently preservation of the uterus and fertility. Intrauterine
administration of methotrexate (MTX) is a conservative and nonsurgical method for
ectopic pregnancy cessation. Methods: We describe two cases of live ectopic pregnancies managed with ultrasound-guided
local injection of MTX complemented with potassium chloride (KCl). A 36-year-old woman
with four previous cesarean scars, live and unruptured uterine ectopic scar pregnancy
was referred to the Interventional Radiology Unit for evaluation and management. She
underwent risk–benefit counseling. Under transvaginal sonographical guidance, puncture
and injection of ectopic pregnancy was performed using a 22G Chiba device. Intrasacular
MTX was injected, which was complemented with fetal intracardiac administration of
KCl. We report another case of 34-year-old woman with 6 weeks ectopic pregnancy at
the site of incision of lower-segment uterine scar pregnancy. Transducer guided 22G
Chiba needle was advanced through the guide into gestational sac, approximately 1
ml of KCl was injected slowly. Afterward, 25 mg (1 ml) MTX was injected into the gestational
sac. Results: Immediate cessation of fetal cardiac activity was noted. Weekly follow-up ultrasounds
for a month remained uneventful with progressive resolution of gestational sac remnant.
Conclusion: Unruptured live ectopic pregnancy can be successfully managed without surgical intervention
through local injection of KCl and MTX preserving uterus.
