Ultrasound-Guided Injection of Ectopic Pregnancy

Several studies have now shown that non-invasive diagnostic algorithms involving the use of highly sensitive and specific immunoassays for human chorionic gonadotrophin (hCG) and high resolution vaginal ultrasound are as accurate as laparoscopy in the diagnosis of ectopic pregnancy. These algorithms also have proved fruitful in making the diagnosis early in the course of the disease before tubal rupture has occurred. In fact, intervention now usually occurs before rupture in greater than 80% of cases. Most importantly, patients diagnosed before tubal rupture are candidates for alternative treatment options besides surgery, including systemic medical management or local ultrasound-directed injection with a number of tropholytic (methotrexate, hyperosmolar glucose, and potassium chloride) agents. These alternative options are attractive because of their ability to avoid the risks of surgery and general anesthesia while also reducing health care costs to the patient.Systemic medical treatment has been discussed elsewhere in this volume, and therefore the remainder of this article will focus on reports in the literature to demonstrate the technique and potential use of transvaginal ultrasound-guided salpingocentesis as a treatment for unruptured ectopic pregnancy.