Kakinuma T, Kakinuma K, Matsuda Y, Yanagida K, Ohwada M, Kaijima H. Efficacy of transvaginal ultrasound-guided local injections of absolute ethanol for ectopic pregnancies with intrauterine implantation sites. World J Clin Cases 2023; 11(4): 788-796 [PMID: 36818618 DOI: 10.12998/wjcc.v11.i4.788]
Corresponding Author of This Article
Toshiyuki Kakinuma, MD, PhD, Doctor, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, Tochigi, Nasushiobara 329-2763, Japan. tokakinuma@gmail.com
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Toshiyuki Kakinuma, Kaoru Kakinuma, Yoshio Matsuda, Kaoru Yanagida, Michitaka Ohwada, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara 329-2763, Japan
Hirotsune Kaijima, Minatomirai Yume Clinic, Yokohama 2200012, Japan
Author contributions: Kakinuma T conceived, designed, and performed the analysis, and wrote the paper; all authors collected and contributed data/analysis tools; all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the International University of Health and Welfare Hospital Ethics Committee (referral number: 21-B-34).
Informed consent statement: Written informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: The authors have no relevant financial or non-financial interests to disclose.
Data sharing statement: The data are available upon reasonable request to the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toshiyuki Kakinuma, MD, PhD, Doctor, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, Tochigi, Nasushiobara 329-2763, Japan. tokakinuma@gmail.com
Received: November 18, 2022 Peer-review started: November 18, 2022 First decision: December 13, 2022 Revised: December 27, 2022 Accepted: January 12, 2023 Article in press: January 12, 2023 Published online: February 6, 2023
Abstract
BACKGROUND
Cervical pregnancies, interstitial tubal pregnancies, and cesarean scar pregnancies, which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean deliveries. The development of high-sensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled treatment. Removal of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been reported. However, delayed resumption of infertility treatments after methotrexate therapy is indicated, and negative effects on the next pregnancy after uterine artery embolization have been reported.
AIM
To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation site.
METHODS
In this study, we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital, between April 2010 and December 2018, and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment outcomes. We evaluated the treatment methods, treatment outcomes, presence of bleeding requiring hemostasis measures and blood transfusion, complications, and treatment periods. Successful treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol alone.
RESULTS
There were 21 total cases comprising 10 cervical pregnancies, 10 interstitial tubal pregnancies, and 1 cesarean scar pregnancy. All patients completed treatment with this method. No massive hemorrhaging or serious adverse reactions were observed during treatment. The mean gestation ages at the time of diagnosis were 5.9 wk (SD, ± 0.9 wk) for cervical and 6.9 wk (SD, ± 2.1 wk) for interstitial tubal pregnancies. The total ethanol doses were 4.8 mL (SD, ± 2.2 mL) for cervical pregnancies and 3.3 mL (SD, ± 2.2 mL) for interstitial pregnancies. The treatment period was 28.5 days (SD, ± 11.7 d) for cervical pregnancies and 30.0 ± 8.1 d for interstitial pregnancies. Positive correlations were observed between the blood β- human chorionic gonadotropin level at the beginning of treatment and the total ethanol dose (r = 0.75; P = 0.00008), as well as between the total ethanol dose and treatment period (r = 0.48; P = 0.026).
CONCLUSION
Transvaginal ultrasound-guided local injections of absolute ethanol could become a new option for intrauterine ectopic pregnancies when fertility preservation is desired.
Core Tip: Transvaginal ultrasound-guided local injections of absolute ethanol for ectopic pregnancies such as cervical pregnancies, interstitial tubal pregnancies, and cesarean scar pregnancies can preserve the uterus without serious adverse reactions. This treatment avoids the complications caused by methotrexate therapy and uterine artery embolization. This treatment may become a new treatment option for intrauterine ectopic pregnancy when fertility preservation is desired.
