Euglycemic ketoacidosis in pregnancy and its management: case report and review of literature

Abstract

afterwards. No subsequent hemodynamic instability or hemorrhage was detected during the 3-months’ follow-up, and ultrasonography at the end of the follow-up showed no change in the appearance of the uterus. Intramural pregnancy is a rare form of ectopic pregnancy – a pregnancy implant within the myometrium, separate from the endometrial cavity and Fallopian tubes [1]. The exact cause is unclear. Possible risk factors include prior uterine trauma, adenomyosis, pelvic surgery, and in vitro fertilization [2]. As for this case, the previous history of surgery for endometriosis and the hysteroscopic findings indicated that the cause might be adenomyosis. In the past, the diagnosis could not be made until the time of surgery for uterine rupture [2]. In the present case, however, early detectionwas possible by liberal use of ultrasonography, MRI and hysteroscopy. A prompt and accurate diagnosis is crucial, avoiding complications such as uterine rupture, which is extremely dangerous and might require hysterectomy, resulting in subsequent loss of fertility [2]. As an ectopic pregnancy, treatment could be surgical, medical or expectant. For the medical approach,methotrexate comes first, andmight even be confidently preferred before surgery in a ruptured ectopic with a hemodynamically stable patient [3]. For this case, the lesion size andb-hCG level indicated that it was in an active state, and the patient had the desire for future fertility, so we chose laparoscopic excision of the lesion. In the procedure, we occluded one uterine artery at the main trunk level first, which temporarily reduced the local blood supply and achieved satisfactory control of bleeding.