ABSTRACT
The treatment of ectopic pregnancies has evolved from a purely surgical route with
routine removal of the fallopian tube to one with multiple options. Medical treatment
can be administered systemically or via local injection. Local delivery of chemotherapeutic
agents is a safe and proven modality that is especially indicated for pregnancies
in which a laparoscopic approach is not ideal and systemic therapy either has failed
or is not desired. Local therapy has the potential to document immediately the cessation
of fetal heart activity. Nontubal ectopic pregnancies may be ideally suited to local
therapy, especially when there is a fetal heart present. Transvaginal ultrasound is
the preferred mode for guidance and laparoscopic guidance has a limited role. Although
a multitude of agents have been proposed, methotrexate, KCl, and hyperosmolar glucose
are the most widely used and readily available. Local therapy has an important place
in the armamentarium of the treatment of ectopic pregnancies.
KEYWORDS
Potassium chloride - methatrexate - local treatment - transvaginal ultrasound - ectopic
pregnancy
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Gary Nathan FrishmanM.D.
Department of Obstetrics and Gynecology, Women & Infants' Hospital, Brown Medical
School
101 Dudley Street, Providence, RI 02905
Email: Gary.Frishman@Brown.edu
