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Transvaginal Local Injection of Hyperosmolar Glucose for the Treatment of Heterotopic Pregnancies

From the ¹Department of Gynecology and Obstetrics, the Cleveland Clinic Foundation, Cleveland, Ohio.

BACKGROUND: We report the technique and long-term outcome after a conservative approach for the treatment of heterotopic pregnancy.

CASE: Two women aged 31 and 30 years presented with heterotopic pregnancies after controlled ovarian hyperstimulation intrauterine insemination. Transvaginal ultrasound-guided needle aspiration of the ectopic gestational sac and instillation of hyperosmolar glucose were performed. The ectopic pregnancies resolved without further intervention in both cases. The intrauterine pregnancies resulted in live births by cesarean delivery. Bilateral tubal patency was subsequently confirmed in both patients.

CONCLUSION: Local injection of 50% glucose after aspiration of the tubal gestational sac fluid under transvaginal ultrasonographic guidance proved effective in resolving the ectopic pregnancy without adversely affecting the concurrent intrauterine pregnancy. This is a simple and inexpensive treatment modality.