IMR Press / CEOG / Volume 48 / Issue 4 / DOI: 10.31083/j.ceog4804154
Open Access Case Report
Diagnosis and management of intramural ectopic pregnancy
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1 Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, 610041 Chengdu, Sichuan, China
2 Department of Obstetrics & Gynecology, West China Second University Hospital, Sichuan University, 610041 Chengdu, Sichuan, China
3 West China Medical School, Sichuan University, 610041 Chengdu, Sichuan, China
Clin. Exp. Obstet. Gynecol. 2021 , 48(4), 974–979; https://doi.org/10.31083/j.ceog4804154
Submitted: 3 August 2020 | Revised: 25 September 2020 | Accepted: 15 October 2020 | Published: 15 August 2021
Abstract

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.

Keywords
Intramural ectopic pregnancy
Minimally invasive surgery
Diagnosis and management
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