Intramyometrial pregnancy after cryopreserved embryo transfer: a case report

Abstract

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.

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

“…In some patients with earlier gestational age and gestational sac protruded to the uterine cavity, hysteroscopic treatment may be more suitable and without abdominal incision. Moreover, uterine artery embolization and aorta balloon occlusion may be effective in reducing the hemorrhage and increase the chance of fertility preservation (7,22,23), and can be combined with other treatment strategies. A comprehensive and objective explanation about the advantages and disadvantages of a variety of treatment options should be carried out when managing patients with intramural pregnancies.…”

“…Surgical removal of conceptus with preservation of uterus should be recommended in those who have a desire for fertility. But uterine surgery itself predisposes patients to intramural pregnancy, so accurate screening needs to be performed to exclude intramural ectopic pregnancy during future conceptions since recurrence of intramural pregnancy has been observed (23).…”

Intramural Pregnancy Misdiagnosed as Gestational Trophoblastic Neoplasia: Case Report and Review of the Literature

“…In our review, the age of patients ranged from 19 to 41-years-old. Except for seven patients, approximately three quarters (77.8%) had a history of uterine trauma [1][2][3][4][5][7][8][9][10][11], including artificial abortion (33.3%), cesarean section (21.4%) and myomectomy (14.3%). One cases (5.6%) experienced intrauterine device (IUD) placement, and two (11.1%) were the result evaluated relatively more effective unless the β-HCG indicates an extraordinarily low concentration [11].…”

“…Besides, the embryo will migrate into the myometrium on account of adenomyosis, together with endometrial tissue. Increased trophoblastic activity and inappropriate decidualization may also be predisposing factors [1][2][3][4][5]. The most common clinical manifestations of intramural pregnancy contain vaginal bleeding and abdominal pain, which are exactly unremarkable.…”

Misdiagnosis of intramural ectopic pregnancy and invasive gestational trophoblastic disease on ultrasound: A challenging case at Tu Du Hospital in Vietnam in COVID-19 pandemic peak and mini-review of literature

“…This uncommon pathology is estimated as less than 1% of ectopic pregnancies. The first case of IEP was reported by Doederlien in 1913 [13] . Before 2013, the literature documented approximately 53 cases around the world [14] .…”