Transvaginal Sonography-Guided Management of Ectopic Pregnancies

While most ectopic pregnancies implant in the fallopian tube, 10% of extrauterine pregnancies occur outside of the fallopian tube posing an even greater potential to cause significant morbidity and mortality [Leite (Rev. Assoc. Med. Bras. 62(2):184–5, 2016)]. These non-tubal or complex ectopic pregnancies, such as cesarean scar, cervical, interstitial, ovarian, and heterotopic pregnancies, may be associated with a delayed presentation and diagnosis and thereby a higher risk of emergent surgery, life-threatening hemorrhage and hysterectomy. Fortunately, due to advances in ultrasound technology and clarifications in the criteria for diagnosing ectopic pregnancies, these pregnancies are detected earlier, allowing for timely and less invasive treatment measures. Local injection of ectopic pregnancies with chemotherapeutic agents in place of, or as an adjuvant to, systemic medical or surgical therapy is becoming established as a safe and effective treatment option in appropriately selected patients [Raughley and Frishman (Semin. Reprod. Med. 25(2):99–115, 2007)].