Spontaneous intramural pregnancy- diagnosis and management

Main Article Content

Fabian Kohls Cordula Schippert Nelmin Rios Guillermo-José Garcia-Rocha Peter Hillemanns Ismini Staboulidou

Abstract

Abstract

We present a case of spontaneous intramural pregnancy.

A 28 year-old woman presented in our clinic because of continued vaginal bleeding (> 17 days). The patient had had no previous operations. Transvaginal ultrasound showed a cystic, vascularized structure on the posterior uterine wall. No intrauterine amniotic sac could be seen in spite of a ß-HCG value of 19.128 U/l, altogether suspicious for an ectopic pregnancy.

Hysteroscopy showed a normal uterine cavity covered with decidua and with no indication of an intracavitary pregnancy or changes in the region of the posterior uterine wall. Laparoscopy demonstrated a bulge of the perimetrium with marked hypervascularisation in the region of the median posterior uterine wall, suggesting an ectopic pregnancy. Laparotomy had to be performed due to suspected placenta tissue deep within the uterine wall and the marked bleeding. All pregnancy material was removed and the bleeding was coagulated. The post-operative course was normal and the ß-HCG value sank below the indicative level.

An intramural gravidity is a very rare occurrence. Early diagnosis and adequate surgical intervention are decisive if the uterus is to be preserved or serious complications such as rupture of the uterus are to be avoided.

Article Details

How to Cite
KOHLS, Fabian et al. Spontaneous intramural pregnancy- diagnosis and management. Medical Research Archives, [S.l.], n. 3, july 2016. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/531>. Date accessed: 29 mar. 2024.
Keywords
ectopic pregnancy, intramural pregnancy, ß-HCG levels, management
Section
Case Reports

References

References
[1] Ong C, Lin-Lin S, Chia D, Choolani M, Biswas AB. Sonographic diagnosis and successful management of an intra-mural ectopic pregnancy. J Clin Ultrasound. 2010;38:320-324.

[2] Bernstein HB, Thrall MM, Clark WB. Expectant management of intramural ectopic pregnancy. Obstet Gynecol 2001;97:826-827.

[3] Ginsburg KA, Quereshi F, Thomas M, Snowman B. Intramural ectopic pregnancy implanting in adenomyosis. Fertil Steril 1989;51:354.

[4] Lu HF, Sheu BC, Shih JC, Chang YL, Tonrg PL, Huang SC. Intramural ectopic pregnancy. Sonographic picture and its relation with adenomyosis. Acta Obstet Gynecol Scand 1997;76:886.

[5] Wong KS, Tan J, Ang C, Ngu A. Myomectomy scar ectopic pregnancy. Aust N Z J Obstet Gynaecol 2010;50:93-94.

[6] Fait G, Goyert G, Sundareson A, Pickens A Jr. Intramural pregnancy with fetal survival: case history and discussion of etiologic factors. Obstet Gynecol 1987;70:472-474.

[7] Kirk E, McDonald K, Rees J, Govind A. Intramural ectopic pregnancy: a case and review of the literature. Eur J Obstet Gynecol Reprod Biol 2013;168:129-133.

[8] Neiger R, Weldon K, Means N. Intramural pregnancy in a cesarean section scar. A case report.J Reprod Med 1998;43:999.

[9] Lee GSR, Hur SY, Kown I, Shin JC, Kim SP, Kim SJ. Diagnosis of early intramural ectopic pregnancy. J Clin Ultrasound. 2005;33:190-192.

[10] Ko HS, Lee Y, Lee HJ, Park IY, Chung DY, Kim SP, Park TC, Shin JC. Sonographic and MR findings in 2 cases of intramural pregnancy treated conservatively. J Clin Ultrasound. 2006;34:356-360.

[11] Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol 2003;21:220-227.

[12] Nabeshima H, Nishimoto M, Utsunomiya H, Arai M, Ugajin T, Terada Y, Yaegashi N. Total laparoscopic conservativesurgery for an intramural ectopic pregnancy. Diagn Ther Endosc 2010;Article ID 504062.doi: 10.1155/2010/504062

[13] Bouzari Z, Keshani M, Yazdani S, Barat S, Zinalzadeh M. Intramural pregnancy. J Obstet Gynaecol 2010;30:195-196.