Distinguishing between intramural pregnancy and choriocarcinoma: A case report

Shan, Shiguang; Chavan, Devendra; Song, Kun Chang; Chi, D.S.; Zhang, Guiyu; Deng, Xiaohui; Li, Li; Kong, Beihua

doi:10.3892/ol.2017.5737

Cited by 19 publications

(12 citation statements)

References 11 publications

(14 reference statements)

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“…The etiological factors of intramyometrial pregnancy include previous uterine trauma, like hysteromyomectomy [11,13], previous curettage [14][15][16][17], cesarean delivery [6], salpingectomy [18], manual removal of placenta, and especially IVF-ET procedure, resulting in a microscopic sinus tract within the endometrium. Embryo may implant into the myometrium with ectopic endometrial tissues during endometriosis development [19][20][21]. During IVF-embryo transfer, embryo could externally migrate and uterine could perforate due to the active trophoblastic in assisted reproductive treatment [10].…”

Section: Discussionmentioning

confidence: 99%

Intramyometrial pregnancy after cryopreserved embryo transfer: a case report

Liu

2020

BMC Pregnancy Childbirth

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Background: Intramyometrial pregnancy is a rare subtype of ectopic pregnancy. The cases following IVF-ET were few reported in recent years. The etiological factors include previous uterine trauma like myomectomy, salpingectomy, dilatation and curettage, assisted reproductive technologies and adenomyosis. Early diagnosis is difficult to make due to its various manifestation. The medical treatment includes conservative management with surgical excision, aortic balloon occlusion, uterine artery embolization, MTX etc. Sometimes hysterectomy was performed due to delayed diagnosis. Case presentation: In this article, we presented a case of a 28 years old woman who had cryopreserved embryo transfer with a history of right side salpingectomy. We suspected it a right adnexa ectopic pregnancy at the first place, especially the right fallopian interstitial or right uterus cornu due to ultrasonography and medical history. The product of conception was discovered embedded in the myometrium and protruding out from the right side of the posterior uterine wall, with seemingly no connection with uterine cavity nor fallopian tubes. The diagnosis of intramural pregnancy was made intraoperatively and validated after pathological report. The interventions were made early enough that exploratory laparoscopy, hysteroscopy and conservative surgical excision were successfully performed at 7 weeks' gestation preserving the fertility. Conclusions: It is important for clinicians to be aware of risk factors of intramural pregnancy and maintain an index of suspicion in ART treatment. Ultrasound and laparoscopy are essential managements for early diagnose which make conservative treatment possible and prevent life-threatening consequences.

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Section: Discussionmentioning

confidence: 99%

Intramyometrial pregnancy after cryopreserved embryo transfer: a case report

Liu

2020

BMC Pregnancy Childbirth

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“…Failure to diagnose an intramural pregnancy can result in catastrophic hemorrhage due to the proximity of the gestational sac to the intramyometrial arcuate vasculature. 9 …”

Section: Discussionmentioning

confidence: 99%

Intramural Ectopic Pregnancy Following Myomectomy

Vagg

Arsala

Kathurusinghe

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

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Intramural pregnancy is a rare form of ectopic pregnancy with early diagnosis essential for prevention of severe hemorrhage and uterine rupture. We report a rare case of an intramural ectopic pregnancy at 12 weeks gestation in a woman 1 year post open myomectomy. Both transvaginal ultrasound and magnetic resonance imaging were utilized as diagnostic aids in this case. The rare nature of this clinical scenario and lack of guidelines for management made clinical decision making difficult. Due to the size and location of the gestational sac, hysterectomy was deemed to be the safest modality, and a midline laparotomy, total abdominal hysterectomy, and bilateral salpingectomy was performed.

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“…The manifestations of intramural ectopic pregnancy such as amenorrhea, lower abdominal pain, and vagal bleeding, are not specific and mimic the symptoms of ectopic pregnancy in other sites (2). These non-specific symptoms can sometimes lead to the misdiagnosis of intramural ectopic pregnancy as myoma, or choriocarcinoma (6). Besides, in previous studies, some patients experiencing intramural ectopic pregnancies reported no discomfort (7), and even the serum β-HCG was negative in one reported case (8).…”

Section: Introductionmentioning

confidence: 89%

Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy

Chen

Gao

et al. 2021

Front. Med.

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Background: Intramural ectopic pregnancy is defined as the gestational sac (GS) is entirely within the myometrium, separate from the endometrial cavity and fallopian tubes, which is unsustainable and potentially life-threatening. The data investigating the clinical characteristics, management strategy, and fertility outcomes after treatment of intramural ectopic pregnancies are very limited due to its extreme rarity.Methods: To investigate the clinical characteristics, treatment options, and fertility outcomes in patients with intramural ectopic pregnancy, a retrospective study included 56 patients was conducted. We also used logistic regression to identify potential risk factors for uterine rupture and hysterectomy in these patients.Results: The mean age of patients was 31.1 years, with an average gestational age (GA) of 10.0 weeks, and the majority of the patient cohort (83.9%) had uterine or endometrial surgical history. 55.4% of the intramural pregnancy was diagnosed by preoperative imaging examination and 67.7% was detected by ultrasound. There was no dominant predisposed zone of the GS. Common treatment strategies included laparotomy surgery (41.1%) and laparoscopic surgery (35.7%), followed by methotrexate (7.1%) and expectant management (5.4%). Uterine rupture occurred in 9 patients and 8 patients underwent a hysterectomy, but no maternal demise was found. Logistic regression showed that a GA >10 weeks predicted a significantly higher risk of uterine rupture (Odds ratio [OR] 8.000, 95% confidence interval [CI] 1.456–43.966, P = 0.017) and hysterectomy (OR 12.333, 95% CI 2.125–71.565, P = 0.005), and GS located in the fundus also predicted higher probability of uterine rupture (OR 7.000,95% CI 1.271–38.543, P = 0.025). Among the ten patients who had a desire for fertility, 6 of them succeeded and 4 of them successfully delivered with a GA ≥ 34 weeks.Conclusion: GA > 10 weeks was the risk factor for both uterine rupture and hysterectomy, while patients with GS located in the uterine fundus had a significantly higher risk of uterine rupture. The fertility outcomes were moderate after treatment. The management strategies should be individualized according to disease conditions and the desire for fertility, and early diagnosis is essential for optimizing clinical outcomes.

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Distinguishing between intramural pregnancy and choriocarcinoma: A case report

Cited by 19 publications

References 11 publications

Intramyometrial pregnancy after cryopreserved embryo transfer: a case report

Intramyometrial pregnancy after cryopreserved embryo transfer: a case report

Intramural Ectopic Pregnancy Following Myomectomy

Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy

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