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Drug exposure during the first trimester of pregnancy and ectopic gestational sac rupture due to overdose: case report In a study of 5 patients with heterotopic pregnancy (HP) treated between 2014 and 2017 at a centre in China, a 27-year-old woman was described, who developed ectopic gestational sac (GS) rupture following treatment with alcohol for HP at an overdose, and she also received sodium-chloride during the first trimester of pregnancy. The pregnant woman (G0P0), who had a history of primary infertility due to bilateral tubal obstruction, underwent frozen-thawed embryo transfer (assisted reproductive technology), wherein two embryos were transferred. At the gestational age of 6+3 weeks, she diagnosed with HP. Therefore, she was scheduled to receive transvaginal ultrasound (TVUS)-guided local injection of alcohol at a centre in China soon thereafter. The ectopic pregnancy (EP) was located in the right fallopian tube. For the TVUS-guided treatment, the vagina and vulva were prepared with sterile sodium-chloride [saline] solution, after which, a needle was used to puncture into the ectopic GS under TVUS guidance. The contents of the GS were suctioned, and then, she received sclerotherapy with TVUSguided local injection of alcohol [absolute ethanol] 2.5mL into the GS based on the size of GS and the volume of the contents suctioned. Following the injection of alcohol, a high-intensity image in injected site was observed under TVUS. She was scheduled to be monitored for 3h following the procedure. However, 2.5h after the treatment, she developed severe lower abdominal pain and dizziness along with abdomen muscle tension and tenderness. An ultrasonography scan showed a large amount of haemorrhagic fluid in the abdominal cavity. She was diagnosed with rupture of EP and haemorrhagic shock. It was noted that she developed ectopic GS rupture secondary to the overdose of injected alcohol. Therefore, the woman underwent laparoscopic surgery. An estimated 2300mL blood was detected in the abdominal cavity, with an active bleeding point in the right tube. Subsequently, the ruptured right tube was resected. Also, 1100mL of autologous blood was re-infused into her body. After the surgery, she recovered well, the remaining intrauterine (IU) sac expanded with the visible heartbeat after 4 days. She was then discharged; however, she experienced an early abortion of IU pregnancy 7 days following surgery. Liu C, et al. The management of heterotopic pregnancy with transvaginal ultrasound-guided local injection of absolute ethanol. Gynecology and Minimally Invasive Therapy 803501939 8: 149-154, No. 4, Oct-Dec 2019. Available from: URL: http://doi.org/10.4103/GMIT.GMIT_4_19

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