First-trimester selective termination in multiple gestation by transvaginal ultrasound-guided intrathoracic injection of potassium chloride

PATIENTS AND METHODS

Selective termination by transvaginal ultrasound-guided intrathoracic injection of potassium chloride (KC1) was performed between 8 and 10 weeks' gestation in eight women with multiple gestation after ovulation induction (6/8) or in vitro fertilization (IVF) (2/8).

RESULTS

Four patients have delivered uneventfully at term, one delivered prematurely at 34 weeks' gestation with good neonatal outcome, and the other 3 patients lead a smooth pregnancy at present. No pregnancy loss or any major complication was found.

CONCLUSIONS

Transvaginal ultrasound-guided intrathoracic injection of KC1 may be the procedure of choice for first-trimester selective termination with acceptable safety. However, more experience is needed to clarify the risk/benefit ratio associated with this procedure.

Successful treatment of two viable tubal pregnancies by two-step local injection

Two viable tubal pregnancies were diagnosed by transvaginal ultrasound with a serum beta-hCG level of up to 3,004 mIU/mL in Case 1 and 16,676 mIU/mL in Case 2. Under transvaginal sonographic guidance, a local injection of potassium chloride (0.5 mL = 1.0 mEq) into the embryo was performed for the purpose of embryocide. In Case 1, a follow-up of serum beta-hCG levels showed an initial plateau and subsequent regression to negative, 49 days after the local injection. However, a persistent increase in serum beta-hCG levels was noted in Case 2 for two samples at intervals of two days during follow-up, 27,800 and 36,500 mIU/mL, in spite of the fact that no fetal cardiac activity was visible. Six days later, laparoscopy was done and methotrexate, 50 mg in 6 mL of normal saline, was injected into the ampullar mass of the right fallopian tube in two divided dosages. The serum beta-hCG levels then gradually decreased and returned to negative 60 days after the methotrexate injection. For a viable ectopic pregnancy, this new modality of two-step local injection, first with potassium chloride and then with supplemental methotrexate, separately by two procedures, may offer an additional choice of conservative treatment.

Jejunal atresia with "apple peel" deformity: report of one case

A case of jejunal atresia with "apple peel" deformity is presented. A 27-year-old woman, gravida 3, para 2, suffered from premature labor pain and vaginal bleeding at 32 weeks of gestation. Prenatal ultrasound examination revealed presence of three areas of cystic dilatation in the fetal abdomen and marked polyhydramnios, indicating a high bowel obstruction. A female baby was delivered by Cesarean section with Apgar scores of 7 and 8 at one and five minutes, respectively. Physical examination showed abdominal distention. Nasogastric tube aspiration got more than 50 ml of blood-tinged fluid. Roentgenography demonstrated a high jejunal obstruction as well as a normally rotated colon. Laparotomy disclosed proximal jejunal atresia with typical "apple peel" appearance of the distal small bowel. An end-to-end anastomosis was performed smoothly after resection of both the proximal and distal small bowels. A reduction tapering antimesenteric jejunoplasty was also done. Partial parenteral nutrition had been administered for 10 days followed by enteric feeding. The postoperative course was uneventful. Her chromosomal analysis revealed a normal karyotype of 46,XX.