REGULAR CONTENT
Final ID
635
Type
Educational Exhibit-Poster Only
Authors
J Lee1, K Langheinrich2, J Smith3
Institutions
1Loma Linda University Medical Center, Irvine, CA, 2N/A, Yucaipa, CA, 3Loma Linda University Medical Center, Loma Linda, CA
Purpose
To provide a novel treatment option for termination of a subhepatic ectopic pregnancy. An illustrative case report and review of the literature will be provided.
Materials & Methods
29 year-old female G7P1051 presented to an outside Emergency Department with abdominal pain and was found to have a positive urine pregnancy test. Pelvic sonography failed to reveal an intrauterine pregnancy. Upon further investigation, a subhepatic ectopic pregnancy was confirmed in Morrison's pouch. Upon transfer, sonography revealed a gestational sac with fetal pole in the hepatorenal space measuring 8 weeks 5 days gestational age. The serum beta-hCG was elevated measuring 37455 mIU/mL. The right upper abdominal quadrant location was further evaluated on MRI.Multidisciplinary consensus between Interventional Radiology, Pediatric Radiology, and Obstetrics and Gynecology was that the best treatment option was percutaneous injection of methotrexate into the gestational sac and potassium chloride into the fetal thorax.
Results
Sonographic evaluation was performed with the patient in a left posterior oblique position under moderate sedation. The gestational sac was verified in the hepatorenal fossa. Using a subcostal trans-hepatic approach, a 20 gauge Chiba needle (Cook Medical Inc., Bloomington, Indiana, U.S.A) was inserted into the gestational sac. Methotrexate 25 mg was injected directly into the gestational sac. The needle was then repositioned into the fetal thorax and potassium chloride 16 mEQ was injected into the fetal heart. Fetal cardiac activity was monitored throughout the performance of the procedure with documentation of cardiac activity prior to treatment and cessation noted upon treatment completion. The needle was then removed and a sterile adhesive bandage was applied to the puncture site. The patient was transferred back to her room in stable condition.Sonography performed on post-operative days #1 and #5 confirmed the absence of fetal cardiac activity. The serum beta-hCG values were also noted to be decreasing.
Conclusions
Fetocide by percutaneous injection of both methotrexate and potassium chloride is a safe and effective option for the treatment of a subhepatic ectopic pregnanc
Final ID
635
Type
Educational Exhibit-Poster Only
Authors
J Lee1, K Langheinrich2, J Smith3
Institutions
1Loma Linda University Medical Center, Irvine, CA, 2N/A, Yucaipa, CA, 3Loma Linda University Medical Center, Loma Linda, CA
Purpose
To provide a novel treatment option for termination of a subhepatic ectopic pregnancy. An illustrative case report and review of the literature will be provided.
Materials & Methods
29 year-old female G7P1051 presented to an outside Emergency Department with abdominal pain and was found to have a positive urine pregnancy test. Pelvic sonography failed to reveal an intrauterine pregnancy. Upon further investigation, a subhepatic ectopic pregnancy was confirmed in Morrison's pouch. Upon transfer, sonography revealed a gestational sac with fetal pole in the hepatorenal space measuring 8 weeks 5 days gestational age. The serum beta-hCG was elevated measuring 37455 mIU/mL. The right upper abdominal quadrant location was further evaluated on MRI.Multidisciplinary consensus between Interventional Radiology, Pediatric Radiology, and Obstetrics and Gynecology was that the best treatment option was percutaneous injection of methotrexate into the gestational sac and potassium chloride into the fetal thorax.
Results
Sonographic evaluation was performed with the patient in a left posterior oblique position under moderate sedation. The gestational sac was verified in the hepatorenal fossa. Using a subcostal trans-hepatic approach, a 20 gauge Chiba needle (Cook Medical Inc., Bloomington, Indiana, U.S.A) was inserted into the gestational sac. Methotrexate 25 mg was injected directly into the gestational sac. The needle was then repositioned into the fetal thorax and potassium chloride 16 mEQ was injected into the fetal heart. Fetal cardiac activity was monitored throughout the performance of the procedure with documentation of cardiac activity prior to treatment and cessation noted upon treatment completion. The needle was then removed and a sterile adhesive bandage was applied to the puncture site. The patient was transferred back to her room in stable condition.Sonography performed on post-operative days #1 and #5 confirmed the absence of fetal cardiac activity. The serum beta-hCG values were also noted to be decreasing.
Conclusions
Fetocide by percutaneous injection of both methotrexate and potassium chloride is a safe and effective option for the treatment of a subhepatic ectopic pregnanc