Intramural ectopic pregnancy

Lu, Hsin-Fen; Sheu, Bor‐Ching; Shih, Jin-Chung; Chang, Yin-Leong; Torng, Pao-Ling; Huang, Su‐Cheng

doi:10.3109/00016349709024372

Cited by 33 publications

(16 citation statements)

References 7 publications

(1 reference statement)

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“…The most accepted theory is that the embryo implants into the myometrium through a microscopic fistula, which may be the consequence of previous uterine surgery, such as a caesarean section or myomectomy (1). Similarly, the embryo may implant into the myometrium together with ectopic endometrial tissues during the development of adenomyosis (4).…”

Section: Discussionmentioning

confidence: 99%

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Distinguishing between intramural pregnancy and choriocarcinoma: A case report

et al. 2017

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Intramural pregnancy is a rare type of ectopic pregnancy with an unclear etiology. It may be associated with uterine wall injury and/or abnormal uterine conditions, such as adenomyosis, in certain cases. In the present report, a case of intramural pregnancy associated with adenomyosis is discussed. The patient was 34 years old and presented with amenorrhea for 40 days. Ultrasonography and magnetic resonance imaging revealed a mixed echogenic mass located within the posterior wall of the uterine fundus with abundant blood flow. In addition, the patient's β-human chorionic gonadotropin levels were markedly elevated; however, these levels demonstrated a declining tendency. Clinically, it was difficult to distinguish the diagnosis of the case between intramural pregnancy and choriocarcinoma. Following initial treatment with methotrexate-based chemotherapy, a laparotomy was performed to confirm the diagnosis and excise the lesion. Pathological analysis confirmed a diagnosis of intramural pregnancy and adenomyosis within the uterine wall. The results of the present case report suggest that surgical intervention should be the first action performed when intramural pregnancy is suspected, in order to confirm the diagnosis and treat the disease.

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Section: Discussionmentioning

confidence: 99%

“…Intramural pregnancy is a rare condition that constitutes <1% of ectopic pregnancies (1). The etiology of intramural pregnancy is unclear.…”

Section: Introductionmentioning

confidence: 99%

Distinguishing between intramural pregnancy and choriocarcinoma: A case report

et al. 2017

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“…It may reflect uterine trauma (previous curettage, cesarean section, myomectomy, etc.) [4, 5], microscopic sinus tracts associated with adenomyosis, invasion of the uterine wall by placenta accreta and subsequent growth of the fetus deep within the myometrium, or external migration and implantation of the ovum on the serosal surface of the uterus [1, 6]. According to Lu et al [1], adenomyosis seems to be the most reasonable factor in the development of intramural pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…[4, 5], microscopic sinus tracts associated with adenomyosis, invasion of the uterine wall by placenta accreta and subsequent growth of the fetus deep within the myometrium, or external migration and implantation of the ovum on the serosal surface of the uterus [1, 6]. According to Lu et al [1], adenomyosis seems to be the most reasonable factor in the development of intramural pregnancy. This is due to the fact that deep adenomyosis has enough endometrial tissue to respond to estrogen and progesterone and demonstrate decidualization, which could be a potential site for blastocyst implantation [1, 7].…”

Section: Discussionmentioning

confidence: 99%

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Ruptured Intramural Pregnancy with Myometrial Invasion Treated Conservatively

Fadhlaoui¹,

Khrouf²,

Nouira³

et al. 2011

Case Reports in Obstetrics and Gynecology

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Background. Intramural pregnancy is a rare form of ectopic pregnancy, difficult to diagnose and generally complicated by uterine rupture. Case. A 38-year-old woman, gravida 5 para 1, was diagnosed with intramural pregnancy by ultrasound and confirmed with MRI. A uterine rupture occurred, which lead to laparotomy and a conservative treatment. Conclusion. Early diagnosis is necessary for conservative treatment.

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Diagnosis of early intramural ectopic pregnancy

Lee

Hur

Kown

et al. 2005

J. Clin. Ultrasound

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Intramural ectopic pregnancy is a very rare diagnosis. Establishing a diagnosis is difficult and is often made intraoperatively. Demonstration of a live extrauterine gestation is the only specific sign of such a pregnancy. A small number of ectopic pregnancies are interstitial or cornual pregnancies. Rupture of an intramural ectopic pregnancy is a serious clinical complication. Diagnosis of this ectopic pregnancy can sometimes be made using 2-dimensional transvaginal ultrasound (TVS), but it may also require 3-dimensional TVS. We present the case of a 25-year-old gravida 0, para 0 woman with amenorrhea lasting 6(+5) weeks. Previous surgery included a right adnexectomy for torsion of a right dermoid cyst. The patient's serum hCG was elevated. TVS provided a detailed view of the endometrial cavity. The results of 2-dimensional TVS suggested the presence of an ectopic pregnancy. The sonogram showed a gestational sac with an embryonic pole and a yolk sac, which was separated from the endometrium. Use of 3-dimensional TVS demonstrated a live embryo in a gestational sac surrounded by myometrium below the right cornu lying outside the endometrium. This finding was confirmed by laparotomy and the conceptus was excised. The patient had an uneventful postoperative course and was discharged 7 days after surgery. In our case, the previous adnexectomy was an identifiable risk factor. Nonetheless, making a diagnosis of an intramural pregnancy was challenging. Suspicion may arise when sonography has revealed an intramural gestational sac.

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Intramural ectopic pregnancy

Cited by 33 publications

References 7 publications

Distinguishing between intramural pregnancy and choriocarcinoma: A case report

Distinguishing between intramural pregnancy and choriocarcinoma: A case report

Ruptured Intramural Pregnancy with Myometrial Invasion Treated Conservatively

Diagnosis of early intramural ectopic pregnancy

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