Intramural Ectopic Pregnancy Research Articles

Risk factors of intramural ectopic pregnancy.

Risk factors of intramural ectopic pregnancy.

Diagnostic and management dilemmas of pregnancies at the utero-tubal junction: A case series and management algorithm.

A pregnancy at the utero-tubal junction is a rare type of ectopic pregnancy and is associated with high maternal morbidity if it remains undetected. In the present study we discuss four cases of ectopic pregnancies at the utero-tubal junction which caused diagnostic and management dilemmas. Four cases of early pregnancies with the gestational sac (G-sac) implanted near the utero-tubal junction are described. In case 1 this was suspected after a failed attempt at dilatation and curettage at our hospital, cases 2 and 3 presented with amenorrhea and pain abdomen and case 4 was diagnosed on first pregnancy documentation scan after frozen embryo transfer. As initial two-dimensional (2D) transvaginal scan (TVS) failed to diagnose the exact location of the G-sac, three-dimensional (3D) TVS helped to localize the exact location of pregnancy and subsequent individualized management. Case 1 had a partial intramural ectopic pregnancy managed by laparotomy and removal of the ectopic sac. The second and third cases were eccentric uterine pregnancies. The fourth was an interstitial ectopic pregnancy managed by a laparoscopic loop and stitch technique. This case series describes the role of 3D TVS for the evaluation of pregnancies implanted at the utero-tubal junction and individual management of eccentric intrauterine, interstitial ectopic and intramural ectopic pregnancies. A diagnostic algorithm for such types of cases and management options is discussed.

EP29.16: Dilemma diagnosis between intramural ectopic pregnancy and invasive gestational trophoblastic disease: a challenging case at Tu Du Hospital in Vietnam

EP29.16: Dilemma diagnosis between intramural ectopic pregnancy and invasive gestational trophoblastic disease: a challenging case at Tu Du Hospital in Vietnam

A detective of intramural ectopic pregnancy: The use of pituitrin under hysteroscopy combined with laparoscopy.

Intramural pregnancy is a rare ectopic pregnancy in which the gestational sac is implanted between the muscle walls. Due to the lack of specific clinical manifestations, it is easy to misdiagnose or miss them. If it is allowed to get worse, the uterus will burst, and there will be a lot of bleeding in the later stages, which could lead to the death of the patient. The patient had no history of uterine surgery, embryo transplantation, or any other operations. She complained of having abdominal distention and swelling of the waist but no vaginal bleeding or lower abdomen discomfort. According to her transvaginal ultrasonography, we highly suspected ectopic pregnancy. Hysteroscopy combined with laparoscopy is an effective treatment option that can prevent life-threatening problems. During the surgery, pituitrin helped find the gestational sac, and the pathology report confirmed that it was an intramural pregnancy. Hysteroscopy combined with laparoscopy is an effective treatment option that can prevent life-threatening problems. During the surgery, we used pituitrin to help find the gestational sac. The use of pituitrin can minimize bleeding during a uterine operation and indicate the location of an intramural pregnancy, helping surgeons to complete the operation successfully. The patient recovered quickly and was discharged on the 4th day after surgery, with a significant decrease in human chorionic gonadotrophin (HCG) levels from 14,792.26 mIU/mL before surgery to 1071.40 mIU/mL at discharge. During the follow up, her HCG level dropped to 50.90 mIU/mL on the 14th day after the surgery. She monitored the HCG levels intermittently until they fell within the normal range. Intramural pregnancy is a rare form of ectopic pregnancy, and it is difficult to diagnose early on. This may result in uterine rupture or even life-threatening hemorrhage. If an intramural pregnancy is suspected in early pregnancy, hysteroscopy combined with laparoscopy is advised, and if necessary, low-dose posterior pituitary hormone can enhance uterine contractions and better reveal the position of the gestational sac within the uterine wall.

High-intensity focused ultrasound ablation combined with systemic methotrexate treatment of intramural ectopic pregnancy: A case report

Intramural ectopic pregnancy (IMP) is a rare ectopic pregnancy with an unclear etiology, and standard treatment guidelines currently remain unclear. The main treatment option is local excision of IMP via laparoscopy or laparotomy. A 32-year-old woman with adenomyosis presented with amenorrhea for 7 weeks and a serum β-human chorionic gonadotropin (HCG) level of 6882 IU/L. The patient had a history of laparotomy for adenomyosis 5 years previously. Three-dimensional ultrasonography showed a live gestational sac (GS) of 9 × 15 × 18 mm located in the left posterior wall of the uterus and a sinus tract connecting the sac and the endometrial cavity. MRI revealed the GS located in the adenomyosis and a 1.0-cm sinus tract connecting the GS and the endometrial cavity. IMP with adenomyosis. High-intensity focused ultrasound (HIFU) treatment combined with systemic methotrexate (MTX) was performed to treat IMP, which would avoid operation and massive bleeding. Serum β-HCG levels decreased to normal 4 weeks after HIFU treatment and the GS was not found on MRI after 4 months. The sinus tract was significantly shortened after the HIFU treatment. HIFU ablation combined with systemic MTX is effective for the treatment of IMP and is favorable for maintaining fertility.

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

Background: Intramural ectopic pregnancy is defined as the gestational sac (GS) is entirely within the myometrium, separate from the endometrial cavity and fallopian tubes, which is unsustainable and potentially life-threatening. The data investigating the clinical characteristics, management strategy, and fertility outcomes after treatment of intramural ectopic pregnancies are very limited due to its extreme rarity.Methods: To investigate the clinical characteristics, treatment options, and fertility outcomes in patients with intramural ectopic pregnancy, a retrospective study included 56 patients was conducted. We also used logistic regression to identify potential risk factors for uterine rupture and hysterectomy in these patients.Results: The mean age of patients was 31.1 years, with an average gestational age (GA) of 10.0 weeks, and the majority of the patient cohort (83.9%) had uterine or endometrial surgical history. 55.4% of the intramural pregnancy was diagnosed by preoperative imaging examination and 67.7% was detected by ultrasound. There was no dominant predisposed zone of the GS. Common treatment strategies included laparotomy surgery (41.1%) and laparoscopic surgery (35.7%), followed by methotrexate (7.1%) and expectant management (5.4%). Uterine rupture occurred in 9 patients and 8 patients underwent a hysterectomy, but no maternal demise was found. Logistic regression showed that a GA >10 weeks predicted a significantly higher risk of uterine rupture (Odds ratio [OR] 8.000, 95% confidence interval [CI] 1.456–43.966, P = 0.017) and hysterectomy (OR 12.333, 95% CI 2.125–71.565, P = 0.005), and GS located in the fundus also predicted higher probability of uterine rupture (OR 7.000,95% CI 1.271–38.543, P = 0.025). Among the ten patients who had a desire for fertility, 6 of them succeeded and 4 of them successfully delivered with a GA ≥ 34 weeks.Conclusion: GA > 10 weeks was the risk factor for both uterine rupture and hysterectomy, while patients with GS located in the uterine fundus had a significantly higher risk of uterine rupture. The fertility outcomes were moderate after treatment. The management strategies should be individualized according to disease conditions and the desire for fertility, and early diagnosis is essential for optimizing clinical outcomes.

Adenomyosis in Pregnancy: Diagnostic Pearls and Pitfalls.

Adenomyosis is a common benign uterine disorder in which ectopic endometrial glands extend into the myometrium. Adenomyosis is increasingly diagnosed in young women, affecting 20%-35% of women of reproductive age. Features of adenomyosis can be seen with either US or MRI, especially with newer imaging technology. With advances in reproductive endocrinology as well as a trend toward later maternal age, adenomyosis is increasingly noted during pregnancy, often while performing imaging for other reasons. Hormonal changes during pregnancy alter the appearance of adenomyosis, which includes diffuse, focal, and cystic adenomyosis. Recognizing these imaging changes in pregnancy proves essential for accurately diagnosing adenomyosis as a benign condition, as it mimics serious placental and myometrial abnormalities. Using a lower-frequency US transducer or MRI can be helpful in distinguishing among these entities. Describing the location of adenomyosis in relationship to the site of placentation is also important. Diagnosing adenomyosis is crucial because it can be associated with poor pregnancy outcomes, including spontaneous abortion, preterm birth, and fetal growth restriction. Adenomyosis is also a risk factor for preeclampsia. Intramural ectopic pregnancy is a rare but serious condition that can mimic cystic adenomyosis, and comparison with prepregnancy images can help differentiate the two conditions. The authors review the unique imaging characteristics of adenomyosis in pregnancy, focusing on accurate diagnosis of an underrecognized benign condition that can mimic myometrial and placental pathologic conditions.©RSNA, 2021.

Diagnosis and management of intramural ectopic pregnancy

Background: Intramural pregnancy is a rare form of ectopic pregnancy where the embryo is implanted within the myometrium, separate from the endometrial cavity. Preoperative diagnosis of intramural pregnancy is difficult and it can easily be misdiagnosed for other diseases such as intrauterine pregnancy or gestational trophoblastic disease. Medical therapy and surgery are used to treat intramural pregnancy, with surgery often being performed via laparotomy and also including hysterectomy. Case: We present a case of intramural pregnancy that was misdiagnosed and wrongly managed by a local hospital. It was finally diagnosed correctly and managed in our hospital by combining hysteroscopy and laparoscopy under the guidance of intra-abdominal ultrasound. Our experience again highlights the difficulty in diagnosing intramural pregnancy preoperatively due to the lack of standard diagnostic criteria. This can in turn lead to inappropriate treatments. Earlier surgical intervention would allow faster diagnosis and also simultaneous treatment of the disease. The majority of intramural ectopic pregnancies have high blood flow that can cause severe hemorrhage and are therefore treated by medication or laparotomy and hysterectomy. Conclusion: Our experience reveals that a minimally invasive procedure is also safe and effective in select cases where advanced endoscopic expertise is available.

Minimally-invasive management of intramural ectopic pregnancy: an eight-case series and literature review

ObjectiveIntramural pregnancy (IMP) is a rare type of ectopic pregnancy and potentially fatal. Early diagnosis and management of IMP are important to preserve patient fertility. Here, we describe the use of minimally-invasive surgery for early IMP. Study designWe retrospectively analyzed the clinical data of eight patients with IMP treated at our center (January 2010 to December 2018) and reviewed the literature describing minimally-invasive treatment of IMP. ResultsAll eight patients had at least one risk factor for IMP. Two cases were confirmed by ultrasound, but ectopic pregnancy or gestational trophoblastic disease were initially suspected in the other cases. Surgery (laparoscopic in three patients, hysteroscopic in one patient, and laparoscopic combined with hysteroscopic in four patients) was successful in all cases, and all patients recovered well without complications. The literature review identified 14 articles describing 17 cases of IMP managed with minimally-invasive surgery. Laparoscopic surgery was used successfully as a sole treatment in 10 cases and after failure of hysteroscopic surgery in six cases. Only one case was treated with a combination of hysteroscopic surgery and methotrexate. Interestingly, one case at our center presented with a sinus connecting the gestational sac and uterine cavity and was treated successfully using hysteroscopic surgery during early pregnancy. ConclusionsLaparoscopic surgery is a feasible management option for most cases of early IMP. Hysteroscopic surgery may be appropriate for cases where a sinus connects the gestational sac with the uterine cavity or when cornual ectopic pregnancy needs to be excluded.

Emergency hysterectomy for a ruptured intramural ectopic pregnancy: A case report

Intramural ectopic pregnancy is usually complicated by uterine rupture requiring emergency laparotomy and appropriate intervention. The diagnosis poses a serious challenge and the type of surgical intervention required depends on the hemodynamic status and the extent of damage to the uterus. A 38-year-old gravida 3, Para 2, abortion 0, who had an emergency hysterectomy due to a ruptured intramural pregnancy with massive hemoperitoneum. Pre-operative ultrasound was suggestive of the diagnosis which was confirmed by operative findings and histopathology report on the specimens. Intravenous infusion of normal saline, blood transfusion and emergency hysterectomy is essential for prevention of maternal mortality in intramural pregnancy complicated by uterine rupture.

Intramural gestation: A rare localization of ectopic pregnancy

Introduction: Intramural pregnancy is a rare form of ectopic pregnancy; it is defined by a gestation within the uterine wall, completely surrounded by myometrium and separated from the uterine cavity and the fallopian tube. Preoperative diagnosis is difficult and hysterectomy may be required due to delay in diagnosis. Case Report: We report a rare case of intramural ectopic pregnancy diagnosed by sonography and treated surgically. Conclusion: Early detection of intramural ectopic pregnancy is needed to prevent complications like uterine rupture and helps preserve fertility.

Partial molar pregnancy at uncommon site as intramural molar ectopic pregnancy

Intramural partial molar ectopic pregnancy is among the rarest sites of molar changes, may mimic intramural myoma and seriously threaten maternal life. The diagnosis and treatment of this unusual site molar ectopic pregnancy present a clinical challenge. We report the case of a partial molar intramural ectopic pregnancy in a 44-year-old patient presented with multiple intramural myoma and confirmed on final histopathology examination.

Intramural Ectopic Pregnancy Following Myomectomy.

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.

Advanced Ultrasound Technology and Its Application to Gynecologic Practice [11P

INTRODUCTION: In 2015, the American Journal of Obstetrics and Gynecology published an opinion supporting ultrasound as the first-line imaging choice in obstetrics and gynecology. Recent advances in 3D gynecologic ultrasound, which includes volumetric calculation and Power Doppler Angiography (PDA) have expanded the practical functionality and diagnostic ability for complex gynecologic conditions. The authors seek to demonstrate this with a case series, comparing the imaging results and the clinical value obtained. METHODS: The described case series includes: 1) Case of missing/broken/embedded IUD complication: located and characterized with 3D gynecologic ultrasound; 2) Case of deeply invasive endometriosis: characterized with 3D gynecologic ultrasound; 3) Improved mapping of uterine fibroids for definitive surgical treatment: characterized by 3D gynecologic ultrasound; 4) Case of endometrial cancerous polyp in a 28 year old, identified with 3D, PDA, volumetric calculation, histogram and Vascularity Index (VI); 5) Case of endometrial carcinoma after negative biopsies: diagnosed via 3D gynecologic ultrasound; 6) Case of an intramural ectopic pregnancy: diagnosed and managed with 3D, PDA, volumetric calculation, histogram and VI. RESULTS: Our case series demonstrates the substantial clinical benefit this modality offers over traditional 2D ultrasound, as well as CT and MRI. Each case shows a unique application of advanced ultrasound technique in gynecologic practice. CONCLUSION: Advances in gynecologic ultrasound are underutilized in current practice. Gynecologists should be aware of the availability and benefits that can result from the use of these advances.

Advanced Hysteroscopic Surgery: Quality Assurance in Teaching Hospitals.

Advanced hysteroscopic surgery (AHS) is a vitally important technique in the armamentarium for the management of many day-to-day clinical problems, such as menorrhagia, surgical excision of uterine myomata and septa in the management of female infertility, hysteroscopic excision of chronically retained products of conception (placenta accreta), and surgical removal of intramural ectopic pregnancy. In today's climate of accountability, it is necessary that gynecologists take a more active role in assuring the quality of their work. In this article, we discuss the quality assurance system from the point of view of the surgical audit meetings in some of the major teaching hospitals affiliated with the University of Queensland (Brisbane, Queensland, Australia).

P24.13: Intramural ectopic pregnancy following IVF‐ET successfully managed with systemic methotrexate

<scp>P</scp>24.13: Intramural ectopic pregnancy following <scp>IVF‐ET</scp> successfully managed with systemic methotrexate

Advanced hysteroscopic surgery training.

Hysteroscopic surgery is pivotal in management of many gynecological pathologies. The skills required for performing advanced hysteroscopic surgery (AHS), eg, transcervical hysteroscopic endometrial resection (TCRE), hysteroscopic polypectomy and myomectomy in the management of menorrhagia, hysteroscopic septulysis in fertility-related gynecological problems and hysteroscopic removal of chronically retained products of conception and excision of intramural ectopic pregnancy ought to be practiced by contemporary gynecological surgeons in their day-to-day clinical practice. AHS is a minimally invasive procedure that preserves the uterus in most cases. Whilst the outcome is of paramount importance, proper training should be adopted and followed through so that doctors, nurses, and institutions may deliver the highest standard of patient care.

Diagnosis and Management of Intramural Ectopic Pregnancy

Intramural pregnancy, a gestation completely surrounded by the myometrium located within the uterine wall with separation from the uterine cavity, is an extremely unusual form of pregnancy. Complications resulting from intramural pregnancy include inevitable uterine rupture with resultant hemorrhage and possible hysterectomy if diagnosis is not made early and treatment is not initiated. An asymptomatic patient was initially diagnosed with a missed abortion at approximately 6 weeks of gestation after a routine ultrasound. Suction curettage was performed approximately 1 month after the initial diagnosis. The pathology specimen failed to reveal placental villi. Ultimately, the diagnosis of intramural pregnancy was made via ultrasound and a computed tomography scan. She was treated with a single dose of systemically administered methotrexate. Over a period of 4 months, β-human chorionic gonadotropin levels trended downward; however, the intramural pregnancy failed to resolve completely, and a persistent mass remained. The intramural pregnancy was removed using the da Vinci laparoscopic procedure (Intuitive Surgical, Sunnyvale, CA). If the diagnosis of intramural ectopic pregnancy is made sufficiently early, conservative measures can be taken, which can preserve a patient’s future fertility.

Diagnosis and management of intramural ectopic pregnancy

Intramural pregnancy is a rare form of ectopic pregnancy, and little is known about its etiology, prevalence and natural history. There is no consensus regarding the ultrasound criteria necessary for the diagnosis of intramural pregnancy, and management strategies vary depending on the severity of clinical presentation, exact location of the pregnancy, viability and gestational age at diagnosis. We present four cases of intramural pregnancy diagnosed in a single institution that illustrate variability in their clinical presentation and difficulty in reaching the correct diagnosis. We also propose a set of ultrasound criteria to facilitate differential diagnosis between intramural and other types of uterine ectopic pregnancy.

Intramural Ectopic Pregnancy: Treatment Using Uterine Artery Embolization

Herein is described the case of a 28-year-old woman in whom uterine artery embolization (UAE) was performed to treat intramural ectopic pregnancy. The intramural ectopic pregnancy was diagnosed at magnetic resonance imaging, which showed a gestational sac surrounded completely by myometrium. The UAE procedure was uncomplicated, with satisfactory results. Intramural ectopic pregnancy may be treated using UAE, which aids in maintaining fertility.