Intramural Ectopic Pregnancy Following Myomectomy.

Deanne Vagg,Shamitha Kathurusinghe,Lima Arsala,W Catarina Ang

doi:10.1177/2324709618790605

Deanne Vagg, Shamitha Kathurusinghe + Show 2 more

Open Access

https://doi.org/10.1177/2324709618790605

Copy DOI

Abstract

Intramural pregnancy is a rare form of ectopic pregnancy with early diagnosis essential for prevention of severe hemorrhage and uterine rupture. We report a rare case of an intramural ectopic pregnancy at 12 weeks gestation in a woman 1 year post open myomectomy. Both transvaginal ultrasound and magnetic resonance imaging were utilized as diagnostic aids in this case. The rare nature of this clinical scenario and lack of guidelines for management made clinical decision making difficult. Due to the size and location of the gestational sac, hysterectomy was deemed to be the safest modality, and a midline laparotomy, total abdominal hysterectomy, and bilateral salpingectomy was performed.

Highlights

Intramural ectopic pregnancy is described as a pregnancy that is partially or completely located within the myometrium of the uterine wall, without connection to the fallopian tubes or endometrial cavity.[1]
The patient underwent surgical management of a benign asymptomatic fibroid in the year prior, which increased her risk of future complications, including ectopic pregnancy, placental adhesive disorders, and uterine dehiscence in future pregnancies.[6]
Surgical management of benign asymptomatic fibroids is controversial, with the general consensus being against surgery if patients are asymptomatic.[7]

Summary

Introduction

Intramural ectopic pregnancy is described as a pregnancy that is partially or completely located within the myometrium of the uterine wall, without connection to the fallopian tubes or endometrial cavity.[1]. Initial management options that were considered included medical management with intra-sac and multidose methotrexate, uterine wedge resection, or hysterectomy. Wedge resection of the uterus was excluded as a viable management option as the location and size of the intramural ectopic pregnancy would result in a large amount of uterine tissue needing to be excised.

Results

Conclusion