Sonographic and MR findings in 2 cases of intramural pregnancy treated conservatively

Abstract

Intramural pregnancy is extremely rare and difficult to diagnose. Because of the high rate of uterine rupture in most cases, hysterectomy is often necessary. The optimal medical management for this condition is unknown. We report 2 cases of intramural pregnancy diagnosed by pelvic MRI and treated with systemic methotrexate.

Intramural pregnancy presenting in a patient with tuberous sclerosis

“…4 We present a case of a ruptured intramural pregnancy diagnosed with US and pelvic MRI in a patient with tuberous sclerosis.…”

Sonographic diagnosis and successful medical management of an intramural ectopic pregnancy

“…6,13,17 For medical treatment, methotrexate can be administered directly to the intramural pregnancy via laparoscopic or transvaginal route, or systemically. 14,16 Although systemic methotrexate treatment and surgery are accepted modalities for tubal pregnancies, they are less effective for intramural pregnancies. 18 Sonographic-guided local methotrexate injections into gestational sacs of intramural pregnancies have been suggested.…”

“…These findings appear to be unique to cases of ectopic pregnancy and cannot be seen with sonography. 14,15 Although more costly than sonography, MRI can be useful in deciding the treatment modality in cases where sonographic diagnosis of an intramural pregnancy is uncertain. In our case, 3D ultrasound was able to delineate the exact location of the GS and to distinguish it from an interstitial ectopic pregnancy.…”

Laparoscopic Management of Interstitial Ectopic Using Simple and Safe Technique: Case Series and Review of Literature

“…The diagnosis is seldom made before uterine rupture or surgery, which could result in life-threatening hemorrhage. In most cases, surgical intervention or even hysterectomy is required [12,13]. Early diagnosis prevents complications and facilitates preservation of fertility.…”

“…The clinicians chose medical treatment, such as systemic/local methotrexate injection or local potassium chloride injection for preserving fertility [12]. Uterine artery embolization also has been tried with preservation of reproductive function but is associated with few adverse effects [15].…”