96 results on '"Intramural pregnancy"'
Search Results
2. Intramural ectopic pregnancy: An individual patient data systematic review
- Author
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Carnot N. Ntafam, ItunuOluwa Sanusi-Musa, and Robert D. Harris
- Subjects
Intramural pregnancy ,Ultrasound ,Magnetic resonance imaging ,Hysteroscopy ,Hysterectomy ,Laparoscopy ,Gynecology and obstetrics ,RG1-991 - Abstract
Intramural pregnancies (IMP) are very rare and represent about 1% of ectopic pregnancies (EPs). Despite a few reported cases, there is limited awareness & knowledge among sonographers and physicians. Moreover, no established diagnostic or treatment protocol exists for such a condition. This study identifies and synthesizes what is known about IMP, including etiology and pathophysiology, common clinical presentations, imaging features, laparoscopic and hysteroscopic findings, and management. PUBMED and Google Scholar were queried to identify eligible studies. All articles on IMP in human subjects available in English and French languages were included. Other types of ectopic pregnancies, including cesarean scar and cervical ectopic pregnancies, were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and a narrative synthesis approach were used to systematically review the medical literature. 82 cases distributed around 27 countries with an average maternal age of 32.07 years and gestational age of 9.27 weeks were eventually selected for this study. History of curettage was the most common risk factor reported in 30 (36.58%) patients, followed by history of salpingectomy, assisted reproduction with embryo transfer, and previous cesarean delivery, in 10(12.19%), 10(12.19%), and 9(10.97%) patients respectively. Ultrasound was performed in 80(97.56%) cases. Of the 66 reported ultrasound findings, 29 were diagnostic or suggestive of IMP. MRI, laparoscopy (both diagnostic & surgical) and diagnostic hysteroscopy were carried out on 18(21.95%), 36(43.9%) and 22(26.83%) patients respectively. Histopathologic examination mainly performed after surgery was the gold standard for confirming the diagnosis. Management involved conservative (3.65%) approach, medical treatment with methotrexate or potassium chloride (23.17%), and surgical interventions. The latter includes laparoscopic surgery (25.61%), laparotomic surgery (23.17%), and hysterectomy (13.41%). IMP is a rare but potentially lethal clinical entity. A significant proportion of patients are asymptomatic and have no known risk factors. Correlation between clinical history and imaging findings is vital to establish a prompt diagnosis and reduce the risk of a catastrophic outcome.
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- 2024
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3. Imaging in gynecological disease (25): clinical and ultrasound characteristics of intramural pregnancy.
- Author
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Nijjar, S., Bottomley, C., Jauniaux, E., and Jurkovic, D.
- Subjects
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FEMALE reproductive organ diseases , *ECTOPIC pregnancy , *MOLAR pregnancy , *VAGINAL hysterectomy , *PREGNANCY , *CHORIONIC gonadotropins , *ULTRASONIC imaging - Abstract
Objective: To describe the clinical and sonographic characteristics of intramural pregnancy, as well as the available management options and treatment outcomes. Methods: This was a retrospective single‐center study of consecutive patients with a sonographic diagnosis of intramural pregnancy between November 2008 and November 2022. An intramural pregnancy was diagnosed on ultrasound when a pregnancy was implanted within the uterine corpus, above the level of the internal cervical os and separate from the interstitial section of the Fallopian tube, and extended beyond the decidual–myometrial junction. Clinical, ultrasound, relevant surgical and histological information and outcomes were retrieved from each patient's record and analyzed. Results: Eighteen patients were diagnosed with an intramural pregnancy during the study period. Their median age was 35 (range, 28–43) years and the median gestational age at diagnosis was 8 + 1 (range, 5 + 5 to 12 + 0) weeks. Vaginal bleeding with or without abdominal pain was the most common presenting symptom, recorded in eight patients. Nine (50%) patients had a partial and nine (50%) had a complete intramural pregnancy. Embryonic cardiac activity was present in eight (44%) pregnancies. The majority of pregnancies (n = 10 (56%)) were initially managed conservatively, including expectant management in eight (44%) cases, local injection of methotrexate in one (6%) and embryocide in one (6%). Conservative management was successful in nine of the 10 (90%) pregnancies, with a median time to serum human chorionic gonadotropin resolution of 71 (range, 35–143) days. One patient with an ongoing live pregnancy had an emergency hysterectomy for a major vaginal bleed at 20 weeks' gestation. No other patient managed conservatively experienced any significant complication. The remaining eight (44%) patients had primary surgical treatment, comprising transcervical suction curettage in seven (88%) of these cases, while one patient presented with uterine rupture and underwent emergency laparoscopy and repair. Conclusions: We describe the ultrasound features of partial and complete intramural pregnancy, demonstrating key diagnostic features. Our series suggests that, when intramural pregnancy is diagnosed before 12 weeks' gestation, it can be managed either conservatively or by surgery, with preservation of reproductive function in most women. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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4. 子宫肌壁间妊娠中期子宫破裂一例.
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周艳, 肖凤仪, 李波, 徐丹, 顾方, and 方恋
- Abstract
Intramural pregnancy is a special type of ectopic pregnancy that is extremely rare in clinic. If the pregnancy continues to second or third trimester of pregnancy, it is very likely to lead to uterine rupture, severe hemorrhage, shock, loss of fertility, and even fatal in severe cases. A case of an intramural pregnancy patient with uterine rupture at 19 weeks was reported. Combined with related case reports, firstly the initial abdominal pain of pregnancy was considered, and then it might be uterine rupture, finally the surgical and postoperative review analysis verified that it was intramural pregnancy rupture. By reviewing the diagnosis and treatment of this patient, summarizing and reviewing relevant literatures, we will strengthen the understanding of such rare pregnancy in order to detect, identify and treat this rare pregnancy earlier, so as to improve the adverse pregnancy outcomes of patients. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Rare case of intramural pregnancy
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Meghna Barmase and Deepa Deewan
- Subjects
intramural pregnancy ,ectopic pregnancy ,medical treatment of intramural pregnancy ,Naval Science ,Medicine - Abstract
Intramural pregnancy is a very rare form of ectopic gestation. There are very few cases published in the literature. The management strategies differ with respect to severity of presentation, average gestational age, and viability of the pregnancy at the time of diagnosis. Here, we report a case of intramural pregnancy, which was managed conservatively with review of data on this rare condition, with respect to its etiology, diagnosis, and treatment.
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- 2020
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6. Successful Pregnancy and Delivery after Uterine Rupture in Previous Pregnancy: A Case Report
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Z Bouzari, M Mohammadnataj, and A Ghanbarpour
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uterine rupture ,pregnancy ,pregnancy outcome ,intramural pregnancy ,Medicine ,Medicine (General) ,R5-920 - Abstract
BACKGROUND AND OBJECTIVE: Uterine rupture in all layers is not only a serious complication of pregnancy but is also associated with maternal and fetal mortality. The usual treatment for uterine rupture is termination of pregnancy, and hysterectomy is necessary in most cases. Successful repair of uterine rupture in all layers is not only uncommon but successful subsequent pregnancy is quite rare. A successful pregnancy is reported in a woman with a history of complete uterine rupture due to intramural pregnancy. CASE REPORT: A 28 – year – old pregnant woman, gravida 4, with a history of two abortions, and one delivery (stillbirth) was admitted to the high-risk pregnancy unit of Ayatollah Rouhani Hospital (Babol, Iran). She had a history of rupture of all layers of the uterus following intramural pregnancy in her third pregnancy, and at that time, she had undergone laparotomy and repair of the uterus. In the fourth pregnancy, due to the history of uterine rupture, she was under prenatal care in high-risk pregnancy unit, and after the onset of contractions at 36 weeks and 2 days, emergency cesarean section was performed for the patient, and the neonate was born with 10/10 APGAR score and a weight of 3000 grams. CONCLUSION: In women who become pregnant after a history of rupture of all layers of the uterus and after the repair of uterine, prenatal and fetal care should be done carefully and cesarean section should be performed immediately after the onset of labor contractions.
- Published
- 2019
7. Intramural Pregnancy: An Intriguing Diagnosis in a Resource Constraint Practice.
- Author
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Lawal OO, Obajimi GO, Okor CM, and Ogunsola JA
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- Humans, Female, Pregnancy, Adult, Pregnancy, Ectopic diagnosis, Abdominal Pain etiology, Laparotomy methods, Abortion, Threatened diagnosis, Ultrasonography, Prenatal methods, Hemoperitoneum diagnosis, Hemoperitoneum etiology
- Abstract
A 30-year-old G4P1+2(1 alive) woman with a history of cervical incompetence initially presented at a gestational age (GA) of 10 weeks and 6 days with lower abdominal pain and was managed conservatively as a case of threatened miscarriage. She re-presented two weeks later and was admitted on account of lower abdominal pain and spotting per vagina of 4hrs duration. An obstetric ultrasound revealed an intrauterine pregnancy invading the posterior myometrium with thinning of the uterine wall and hemoperitoneum. She subsequently had an exploratory laparotomy, evacuation of the hemoperitoneum, separation of the fetus from the myometrium, and repair with no. 2 vicryl suture. The patient recovered satisfactorily and had two units of whole blood transfused. She was managed with analgesics, hematinics and broad-spectrum antibiotics. She was discharged on the 4th post-operative day to be followed up at the gynaecological clinic., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)
- Published
- 2024
8. Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy
- Author
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Xiaoran Chen, Lingyun Gao, Hongna Yu, Meijuan Liu, Shujun Kong, and Sijian Li
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intramural pregnancy ,ectopic pregnancy ,treatment ,maternal outcomes ,risk factors ,Medicine (General) ,R5-920 - Abstract
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.
- Published
- 2021
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9. A case of intramural pregnancy: Differential diagnosis for distinguishing from retained products of conception and gestational trophoblastic disease
- Author
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Qing- Yun Song, Fan Yang, and Hong Luo
- Subjects
gestational trophoblastic disease ,intramural pregnancy ,retained products of conception ,ultrasound ,Gynecology and obstetrics ,RG1-991 - Abstract
Intramural pregnancy refers to the implantation of fertilized eggs in uterine musculature, separated from the uterine cavity and tube. We report a case of intramural pregnancy previously misdiagnosed as retained products of conception and gestational trophoblastic disease. This case highlights the difficulty in the diagnosis of intramural pregnancy. Clinicians should be clear about the risk factors of the disease. Judicious selection of the appropriate imaging modalities is vital to making an accurate diagnosis and providing effective treatment.
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- 2020
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10. Intramural pregnancy at 6 and 8 weeks gestation with no predisposing factors: As two uncommon case reports.
- Author
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Aouragh A, Boukroute M, Aloua YE, Regragui A, Bellajdel I, Taheri H, Saadi H, and Mimouni A
- Abstract
Ectopic pregnancies are extremely rare causing severe consequences such as uterine rupture and may lead to death. The clinical symptomatology is very atypical, essentially pelvic pain and metrorrhagia, for this reason, a misdiagnosis can be fatal. Here we report two cases of an intramural pregnancy in a 33-year-old primigravida at 6 weeks gestation after a medically assisted reproduction and a 26-year-old primigravida at 8 weeks gestation with no predisposing factors, making the diagnosis more challenging., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)
- Published
- 2024
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11. Intramural pregnancy: A case report
- Author
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Juliane Nees, Gesine Faigle-Krehl, Janina Brucker, Dagmar Leucht, Lisa Katharina Platzer, Christa Flechtenmacher, Christoph Sohn, and Markus Wallwiener
- Subjects
Ectopic pregnancy ,Intramural pregnancy ,Case report ,Early pregnancy ,Uterine wedge resection ,Surgery ,RD1-811 ,Gynecology and obstetrics ,RG1-991 - Abstract
A 24-year-old woman, who had undergone neither fertility treatment nor uterine surgery other than a cesarean section, presented with an intramural ectopic pregnancy. A laparotomy with uterine wedge resection including the embryonic tissue was performed. The postoperative course was uneventful, with falling βHCG levels. Two months after surgery she presented again with an intrauterine pregnancy.
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- 2020
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12. Minimally-invasive management of intramural ectopic pregnancy: an eight-case series and literature review.
- Author
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Shen, Zhaojun, Liu, Chunlei, Zhao, Li, Xu, Luhang, Peng, Bin, Chen, Zhengyun, Li, Xiaoyong, and Zhou, Jianhong
- Subjects
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ECTOPIC pregnancy , *GESTATIONAL trophoblastic disease , *LITERATURE reviews , *HYSTEROSCOPIC surgery , *LAPAROSCOPIC surgery , *ULTRASONIC imaging , *RETROSPECTIVE studies , *METHOTREXATE , *LAPAROSCOPY - Abstract
Objective: Intramural 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 Design: We 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.Results: All 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.Conclusions: Laparoscopic 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. [ABSTRACT FROM AUTHOR]- Published
- 2020
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13. Intramural ectopic pregnancy following pelvic adhesion: case report and literature review.
- Author
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Zhang, Qi, Xing, Xiaoxiao, Liu, Shuiqing, Xie, Xiao, Liu, Xia, Qian, Feng, and Liu, Yanping
- Subjects
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ECTOPIC pregnancy , *CHILDBIRTH , *LITERATURE reviews , *UTERINE hemorrhage , *FALLOPIAN tubes , *UTERINE surgery - Abstract
Background: Intramural pregnancy is an uncommon type of ectopic pregnancy, where the gestational sac is completely encircled by myometrium and unconnected with endometrial cavity, fallopian tubes or round ligament. Owing to its potentially life-threatening hemorrhage and uterine rupture, early diagnosis and management are urgently required. We present a case of a woman undergoing zigzag medical procedures, which featured non-consensus preoperative diagnosis of intramural and interstitial pregnancy and an intramural ectopic pregnancy ultimately confirmed and successfully removed by emergency laparoscopy. Additionally, we present a review of the related literature and discuss its varied clinical features, imageological characters, diagnosis, differential diagnosis and multiple treatments.Methods: A comprehensive bibliographic search through PubMed, using keywords: intramural ectopic pregnancy. Relevant literatures published from January 2013 to April 2019 were reviewed.Results: Twenty-four cases in total for intramural ectopic pregnancy including this report were reviewed. Diagnoses were mainly made by ultrasound images. Most patients had a history of uterine surgery or intrauterine operation and had been surgically resected. None of the mothers were in danger, but only one case had live birth at 37 weeks of gestation.Conclusion: Non-specific clinical presentation and non-uniform ultrasound criteria pose a challenge for us to make timely and accurate management. Integrated radiological examinations and communication and cooperation between sonographers and gynecologists play a vital role in diagnostic accuracy and selecting the optimal therapeutic method of an intramural pregnancy. [ABSTRACT FROM AUTHOR]- Published
- 2019
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14. Intramural Pregnancy
- Author
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Memtsa, Maria, Jurkovic, Davor, and Tulandi, Togas, editor
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- 2015
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15. Intramural ectopic pregnancy: An individual patient data systematic review.
- Author
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Ntafam CN, Sanusi-Musa I, and Harris RD
- Abstract
Intramural pregnancies (IMP) are very rare and represent about 1% of ectopic pregnancies (EPs). Despite a few reported cases, there is limited awareness & knowledge among sonographers and physicians. Moreover, no established diagnostic or treatment protocol exists for such a condition. This study identifies and synthesizes what is known about IMP, including etiology and pathophysiology, common clinical presentations, imaging features, laparoscopic and hysteroscopic findings, and management. PUBMED and Google Scholar were queried to identify eligible studies. All articles on IMP in human subjects available in English and French languages were included. Other types of ectopic pregnancies, including cesarean scar and cervical ectopic pregnancies, were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and a narrative synthesis approach were used to systematically review the medical literature. 82 cases distributed around 27 countries with an average maternal age of 32.07 years and gestational age of 9.27 weeks were eventually selected for this study. History of curettage was the most common risk factor reported in 30 (36.58%) patients, followed by history of salpingectomy, assisted reproduction with embryo transfer, and previous cesarean delivery, in 10(12.19%), 10(12.19%), and 9(10.97%) patients respectively. Ultrasound was performed in 80(97.56%) cases. Of the 66 reported ultrasound findings, 29 were diagnostic or suggestive of IMP. MRI, laparoscopy (both diagnostic & surgical) and diagnostic hysteroscopy were carried out on 18(21.95%), 36(43.9%) and 22(26.83%) patients respectively. Histopathologic examination mainly performed after surgery was the gold standard for confirming the diagnosis. Management involved conservative (3.65%) approach, medical treatment with methotrexate or potassium chloride (23.17%), and surgical interventions. The latter includes laparoscopic surgery (25.61%), laparotomic surgery (23.17%), and hysterectomy (13.41%). IMP is a rare but potentially lethal clinical entity. A significant proportion of patients are asymptomatic and have no known risk factors. Correlation between clinical history and imaging findings is vital to establish a prompt diagnosis and reduce the risk of a catastrophic outcome., Competing Interests: All three authors have NO conflict of interest to declare., (© 2024 The Authors.)
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- 2023
- Full Text
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16. A case of intramural pregnancy: Differential diagnosis for distinguishing from retained products of conception and gestational trophoblastic disease.
- Author
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Song, Qing-, Yang, Fan, and Luo, Hong
- Abstract
Intramural pregnancy refers to the implantation of fertilized eggs in uterine musculature, separated from the uterine cavity and tube. We report a case of intramural pregnancy previously misdiagnosed as retained products of conception and gestational trophoblastic disease. This case highlights the difficulty in the diagnosis of intramural pregnancy. Clinicians should be clear about the risk factors of the disease. Judicious selection of the appropriate imaging modalities is vital to making an accurate diagnosis and providing effective treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
17. Myomectomy Scar Pregnancy: A Rare Complication of Myomectomy.
- Author
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Paul, P.G., Mannur, Sumina, Shintre, Hemant, Paul, George, and Gulati, Gunjan
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DATABASES , *ELECTRONICS , *UROLOGICAL surgery , *PREGNANCY complications , *SCARS , *SYSTEMATIC reviews , *DISEASE complications - Abstract
Background: Myomectomy scar pregnancy is a rare form of intramural pregnancy in which the gestational sac is implanted within the myometrium, separate from the endometrial cavity and fallopian tubes and in the previous myomectomy scar. This review was written to increase awareness about the rare complication of intramural scar pregnancy after myomectomy. Illustrated by a case report of a myomectomy scar pregnancy following laparoscopic myomectomy, the review covers 3 cases reported in the literature. Illustrative Case: A 31-year-old female, gravida 3, with a history of myomectomy presented to the Centre for Advanced Endoscopy and Infertility of Paul's Hospital in Kochi, Kerala, India, at 9 weeks of gestation for confirmation of fetal viability. A transvaginal ultrasound scan indicated that there was a potential left interstitial pregnancy. However, laparoscopy revealed that this patient actually had an intramural pregnancy in her previous myomectomy scar. This patient's condition was managed successfully via laparoscopy. Results: An electronic database search yielded 68 cases of intramural scar pregnancy. However, only 3 cases of intramural scar pregnancies after myomectomy were identified. Conclusion: An unusual location of an early pregnancy on TVS should raise the suspicion of myomectomy scar ectopic pregnancy in a woman with a previous myomectomy. (J GYNECOL SURG 34:53) [ABSTRACT FROM AUTHOR]
- Published
- 2018
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18. Ultrasound diagnosis of intramural pregnancy.
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Liu, Na ‐ na, Han, Xue ‐ song, Guo, Xi ‐ juan, Sun, Li ‐ tao, and Kong, Xian ‐ chao
- Subjects
- *
DIFFERENTIAL diagnosis , *ECTOPIC pregnancy , *ENDOMETRIUM , *ENDOSCOPIC ultrasonography , *FALLOPIAN tubes , *MYOMETRIUM - Abstract
Intramural pregnancy is a rare type of ectopic pregnancy, where the gestational sac is implanted inside the myometrium instead of the endometrial and fallopian tubes. Preoperative diagnosis remains very difficult. Ultrasonic findings vary according to the anatomical location or duration of pregnancy. In this study, we summarized the ultrasonic characteristics of intramural pregnancy by assessing three cases. We also propose a set of ultrasonic characteristics to facilitate differential diagnosis between intramural pregnancy and other types of ectopic pregnancy. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
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19. 子宫肌壁间妊娠的临床分析.
- Author
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张惠惠 and 李爱军
- Abstract
Objective: To identify the clinical features, relevant risk factors, differential diagnosis and treatment of the intramural pregnancy. Methods:Retrospective analysis of the surgery history, clinical features, auxiliary examination, diagnosis, treatment process and pathologic results on 4 patients admitted to our hospital with intramural pregnancy in 5 years. To understand the risk factors, differential diagnosis and treatment of the intramural pregnancy. Results:Four patients all belonged to the mass type of the intramural pregnancy. B-mode MRI diagnoses pregnancy in uterine horn and gestational trophoblastic neoplasia. All of the four patients accept hysteroscopy combined with laparoscopy surgery and supervise hCG concentration dropping to the normal level. Conclusions:In the clinical medicine, doctor should pay attention to the patient of incomplete abortion with hCG not dropping to the normal level or increasing, vaginal bleeding and B-mode ultrasound and MRI showing mesometrium mass. [ABSTRACT FROM AUTHOR]
- Published
- 2017
20. Rare case of intramural pregnancy
- Author
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Deepa Deewan and Meghna Barmase
- Subjects
Pregnancy ,medicine.medical_specialty ,lcsh:V ,Ectopic pregnancy ,business.industry ,Obstetrics ,Intramural pregnancy ,medical treatment of intramural pregnancy ,lcsh:R ,Gestational age ,lcsh:Medicine ,medicine.disease ,intramural pregnancy ,Rare case ,medicine ,Etiology ,Gestation ,ectopic pregnancy ,Presentation (obstetrics) ,business ,lcsh:Naval Science - Abstract
Intramural pregnancy is a very rare form of ectopic gestation. There are very few cases published in the literature. The management strategies differ with respect to severity of presentation, average gestational age, and viability of the pregnancy at the time of diagnosis. Here, we report a case of intramural pregnancy, which was managed conservatively with review of data on this rare condition, with respect to its etiology, diagnosis, and treatment.
- Published
- 2020
21. Management of Unusual Not Scar Ectopic Pregnancy: A Multicentre Retrospective Case Series
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Isabel Peterlunger, Antonino Farulla, Piero Malorgio, C. Alboni, G. Bolomini, Enrico Fontana, Silvia Ficarelli, Federico Ferrari, Franco Odicino, Benedetta Cornelli, Anna Chiara Boschi, Enrico Sartori, Giuseppe Ricci, Martina Leombroni, Giovanni Scambia, Antonio Simone Laganà, Filippo Alberto Ferrari, Giuliana Beneduce, Massimo Franchi, Marianna Roccio, Maria Cristina Moruzzi, Danilo Buca, Ferrari, F., Ficarelli, S., Cornelli, B., Ferrari, F. A., Farulla, A., Alboni, C., Fontana, E., Roccio, M., Boschi, A. C., Buca, D., Leombroni, M., Peterlunger, I., Moruzzi, M. C., Beneduce, G., Bolomini, G., Lagana, A. S., Malorgio, P., Ricci, G., Franchi, M., Scambia, G. -V., Sartori, E., and Odicino, F.
- Subjects
Ectopic pregnancy ,cornual pregnancy ,interstitial pregnancy ,cervical pregnancy ,ovarian pregnancy ,abdominal pregnancy ,hepatic pregnancy ,angular pregnancy ,intramural pregnancy ,medicine.medical_specialty ,Series (stratigraphy) ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,medicine ,business - Abstract
Background: Management of unusual not scar ectopic pregnancies (UNSEPs) is an unexplored clinical field because of their low incidence and lack of guidelines. Objective: To report the clinical presentation, the first- and second-line treatment and outcomes of UNSEPs. Methods: We retrospectively collected patients treated for UNSEP (namely cervical, interstitial, ovarian, angular, abdominal, cornual and intramural), their baseline characteristics, risk factors, symptoms, diagnostic pathway and the type of first-line treatment (medical, surgical or combined). We further collected treatment failures and the type of second- line treatment. We assessed treatment outcomes, time to serum beta human chorionic gonadotropin (β-hCG) level negativity, length of recovery, follow up and return to a normal menstrual cycle. Results: From 2009 to 2019, we collected 79 cases. Of them, 27 (34%), 23 (29%), 12 (15%), 8 (10%), 6 (8%) and 3 (4%) were cervical, interstitial, ovarian, angular, abdominal and cornual, respectively. Forty women (50.6%) were submitted to medical treatment, mostly methotrexate based; conversely, 36 patients (45.6%) underwent surgery and only 3 women (3.8%) received a combined treatment. The success of first-line treatment rate, regardless of UNSEP location, was 53% and 89% for medical and surgical treatment, respectively. Treatment failures (21 patients) were submitted to second-line treatment, respectively 47.6% and 52.4% to medical and surgical approach. Of interest, cervical pregnancies achieved the lowest rate of first-line medical treatment success (22%) and received more frequently (69%) a subsequent surgical approach with no hysterectomy. Interstitial pregnancies were submitted to surgery mostly for a matter of urgency (71%), otherwise, they were treated with a medical approach both at first- and second-line treatment. Ovarian pregnancies were treated with ovariectomy in 44% of the cases submitted to surgery. Angular pregnancies underwent surgery more often, while all the abdominal pregnancies underwent endoscopic or open surgery. Cornual pregnancies received cornuostomy in 75% of the cases. Overall, the need for blood transfusion was 23.1% among the patients submitted to surgery. The median length of hospitalisation was shorter for women submitted to surgical first-line treatment (5 vs. 10 days; p = 0.002). In case of first-line medical treatment and in case of failure, we found an increase of 3 days (CI95% 0.6-5.5; p = 0.01) and of 3.6 days (CI95% 0.89-6.30; p = 0.01) in the length of hospitalisation, respectively. Negative β-HCG levels were obtained earlier in the surgical group (median 25 vs. 51 days; p = 0.001), as well as the return to normal menstrual cycle (median 31 vs. 67 days; p < 0.000). Post-treatment follow-up, regardless of the failure of first-line treatment was shorter in the surgical group (median 32 versus 68 days; p= 0.003). Conclusion: Cervical pregnancies were successfully managed with a surgical approach without hysterectomy, and hence, we suggest avoiding medical treatment. No consensus emerged for other UNSEPs. Ovarian, angular and interstitial pregnancies are burdened by a non-conservative approach on the utero-ovarian structures. The surgical approach led to shorter recovery, earlier β-hCG negativity and shorter follow-up, even though there is an increased risk for blood transfusion.
- Published
- 2022
22. Intramural Pregnancy Misdiagnosed as Gestational Trophoblastic Neoplasia: Case Report and Review of the Literature
- Author
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Yan Hu and Lejing Zang
- Subjects
medicine.medical_specialty ,business.industry ,Obstetrics ,Intramural pregnancy ,Medicine ,Gestational trophoblastic neoplasia ,business - Published
- 2021
23. Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy
- Author
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Meijuan Liu, Ling-Yun Gao, Shujun Kong, Hongna Yu, Sijian Li, and Xiaoran Chen
- Subjects
medicine.medical_specialty ,Medicine (General) ,medicine.medical_treatment ,Gestational sac ,R5-920 ,medicine ,risk factors ,Risk factor ,Original Research ,Hysterectomy ,Ectopic pregnancy ,treatment ,Obstetrics ,business.industry ,maternal outcomes ,Gestational age ,Retrospective cohort study ,General Medicine ,Odds ratio ,medicine.disease ,Uterine rupture ,intramural pregnancy ,medicine.anatomical_structure ,Medicine ,ectopic pregnancy ,business - Abstract
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.
- Published
- 2021
24. Intramural pregnancy following transcervical resection of adhesion: a case and review literatures
- Author
-
W.D. Zou, Z.W. Liu, and J. Zhang
- Subjects
medicine.medical_specialty ,Reproductive Medicine ,business.industry ,Intramural pregnancy ,medicine ,Obstetrics and Gynecology ,Adhesion (medicine) ,business ,medicine.disease ,Transcervical resection ,Surgery - Published
- 2019
25. Advanced Diagnostic Topic for Austere Providers: Obstetric
- Author
-
Sarah C. Crockett and Zachary P. Soucy
- Subjects
Position (obstetrics) ,Ectopic pregnancy ,Health care provider ,business.industry ,Point of care ultrasound ,Intramural pregnancy ,Medicine ,Fetal head ,Medical emergency ,business ,medicine.disease ,Fetal Heart Tone ,Free fluid - Abstract
Point of care ultrasound (POCUS) can aid the health care provider with management of obstetrical and gynecological emergencies in the prehospital and austere setting. This chapter will focus on (1) identification of IUP, (2) detection of fetal heart tones (FHTs) and (3) determination of fetal head position as well as the relevant anatomy, scanning technique, and limitations. In addition, POCUS can be used to identify free fluid in the abdomen which could be secondary to trauma in the gravid patient, ectopic pregnancy, intramural pregnancy, or other causes of intra-abdominal hemorrhage.
- Published
- 2021
26. Ruptured Intramural Pregnancy with Low and Declining β-human Chorionic Gonadotropin Levels
- Author
-
Yu-Hung Lin, Kok-Min Seow, Lee-Wen Huang, and Jiann-Loung Hwang
- Subjects
ectopic pregnancy ,intramural pregnancy ,Gynecology and obstetrics ,RG1-991 - Abstract
Objective: Intramural pregnancy is the rarest type of ectopic pregnancy and its diagnosis is usually not made until surgery. This case of intramural pregnancy had an unusual course and an ultrasound appearance not previously reported. Case Report: A 29-year-old woman presented with vaginal bleeding. Ultrasound revealed an empty uterus and a heterogeneous mass at the fundus that displayed prominent blood flow on color Doppler and power Doppler ultrasound. Initial serum β-human chorionic gonadotropin (β-hCG) level was 441 mIU/mL and dropped to 295 mIU/mL 2 days later. The woman, however, had heavy vaginal bleeding on the following day. The mass was excised at emergency laparotomy. The pathologic report confirmed the diagnosis of intramural pregnancy. Conclusion: Intramural pregnancy may appear as a heterogeneous mass with prominent blood flow on Doppler ultrasound. The possibility of rupture should be kept in mind even if serum β-hCG is low and keeps falling.
- Published
- 2005
- Full Text
- View/download PDF
27. Intramural pregnancy: A case report
- Author
-
Janina Brucker, Dagmar Leucht, Christa Flechtenmacher, Juliane Nees, Lisa Katharina Platzer, C. Sohn, Gesine Faigle-Krehl, and Markus Wallwiener
- Subjects
medicine.medical_specialty ,Ectopic pregnancy ,medicine.medical_treatment ,media_common.quotation_subject ,lcsh:Surgery ,Early pregnancy factor ,Fertility ,Intrauterine pregnancy ,lcsh:Gynecology and obstetrics ,Article ,03 medical and health sciences ,Uterine wedge resection ,0302 clinical medicine ,Laparotomy ,Case report ,medicine ,030212 general & internal medicine ,Early pregnancy ,lcsh:RG1-991 ,media_common ,Uterine surgery ,030219 obstetrics & reproductive medicine ,biology ,business.industry ,Intramural pregnancy ,Obstetrics and Gynecology ,lcsh:RD1-811 ,medicine.disease ,Surgery ,biology.protein ,business ,Wedge resection (lung) - Abstract
A 24-year-old woman, who had undergone neither fertility treatment nor uterine surgery other than a cesarean section, presented with an intramural ectopic pregnancy. A laparotomy with uterine wedge resection including the embryonic tissue was performed. The postoperative course was uneventful, with falling βHCG levels. Two months after surgery she presented again with an intrauterine pregnancy., Highlights • An 8-week, viable, intramural ectopic pregnancy in an asymptomatic woman after c-section 5 months earlier is reported. • Management of such a case may be medical or surgical. • The patients elected to have surgery. • Follow-up is requiered until human chorionic gonadotropin levels have normalized.
- Published
- 2020
28. Myomectomy Scar Pregnancy: A Rare Complication of Myomectomy
- Author
-
P.G. Paul, Sumina Mannur, Hemant Shintre, George Paul, and Gunjan Gulati
- Subjects
Gynecology ,medicine.medical_specialty ,Pregnancy ,030219 obstetrics & reproductive medicine ,Ectopic pregnancy ,medicine.diagnostic_test ,business.industry ,Intramural pregnancy ,Gestational sac ,Myometrium ,Obstetrics and Gynecology ,medicine.disease ,Surgery ,Endometrial cavity ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,Complication ,business ,Laparoscopy - Abstract
Background: Myomectomy scar pregnancy is a rare form of intramural pregnancy in which the gestational sac is implanted within the myometrium, separate from the endometrial cavity and fallo...
- Published
- 2018
29. Postmolar choriocarcinoma after an interval of 7 years: Case report and literature review
- Author
-
Min-Min Hou, Mingrong Qie, and Lian Xu
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Malignancy ,Surgical specimen ,lcsh:Gynecology and obstetrics ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Laparoscopy ,Pathological ,neoplasms ,reproductive and urinary physiology ,lcsh:RG1-991 ,Pregnancy ,030219 obstetrics & reproductive medicine ,Hysterectomy ,medicine.diagnostic_test ,business.industry ,Intramural pregnancy ,General surgery ,Choriocarcinoma ,Obstetrics and Gynecology ,medicine.disease ,female genital diseases and pregnancy complications ,030220 oncology & carcinogenesis ,embryonic structures ,business - Abstract
Choriocarcinoma is a rare pregnancy-related malignancy. The majority is arising from non-molar pregnancy. Here we report a patient who was diagnosed with postmolar choriocarcinoma after an interval of 7 years. Before surgery, we suspected the diagnosis of the patient was intramural pregnancy or choriocarcinoma. Laparoscopy was performed and hysterectomy was carried out. Postoperative pathological evaluation of the surgical specimen confirmed the case was choriocarcinoma. Hysterectomy through laparoscopy was feasible and safe for selected patients. Keywords: Choriocarcinoma, Hysterectomy, Laparoscopy
- Published
- 2017
30. Diagnosis and management of intramural ectopic pregnancy.
- Author
-
Memtsa, M., Jamil, A., Sebire, N., Jauniaux, E., and Jurkovic, D.
- Subjects
- *
ECTOPIC pregnancy , *GESTATIONAL age , *PREGNANCY , *DIFFERENTIAL diagnosis , *MEDICAL imaging systems , *DIAGNOSIS - Abstract
ABSTRACT 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. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
31. Early Detection and Minimally Invasive Management of Intramural Pregnancy.
- Author
-
Wu, Pei-Ju, Han, Chien-Min, Wang, Chin-Jung, and Lee, Chyi-Long
- Abstract
Abstract: Intramural pregnancy is a rare form of ectopic pregnancy, wherein the fetus is implanted within the myometrium, separate from the endometrial cavity. In the early reported cases, a diagnosis was only possible after an operation for uterine rupture; however, recent developments in ultrasonography and magnetic resonance imaging assist in early diagnosis. Early diagnosis prevents potential life-threatening hemorrhage and preserves fertility. Both medical therapy and surgery are used to treat intramural pregnancy: surgery is often performed via laparotomy and includes hysterectomy. Here, we report the first case of successfully combining hysteroscopy and laparoscopy in the early diagnosis and management of intramural pregnancy. Our experience reveals that the minimally invasive procedure is safe and effective in select cases where advanced endoscopic expertise is available. [Copyright &y& Elsevier]
- Published
- 2013
- Full Text
- View/download PDF
32. Subserosal intramural ectopic pregnancy in an adenomyotic area following assisted reproduction treatment.
- Author
-
Abdel-Gadir, Ahmed, Shah, Kishor, Oyawoye, Oluseye, and Chander, Bina
- Abstract
A 38-year-old woman presented for early pregnancy ultrasound scanning 6 weeks and 4 days following an assisted reproduction treatment cycle. She had ß human chorionic gonadotrophin (ßhCG) blood level of 10,853 IU/L 2 weeks before presentation. She gave previous history of termination of pregnancy, myomectomy and bilateral salpingectomy. The uterus was retroverted with multiple fibroids and non-homogenous myometrium in many areas. The endometrium was 21.1 mm thick with no intrauterine pregnancy. An initial diagnosis of cornual/interstitial ectopic pregnancy was made. However, 3D images rendering and the multiplanar technique showed a 27.5-mm gestation sac, medial and above the interstitial part of the right tube, with 7.6-mm-long foetal pole. ßhCG and progesterone blood levels on the same day were 19,551 IU/L and 43.2 nmol/l, respectively. The patient opted against methotrexate treatment. An ectopic pregnancy bulging out of the fundal area was excised laparoscopically. Histopathological assessment showed chorionic villi surrounded by myometrium, as well as foci of adenomyosis, reaching the outer serosa. To our knowledge, this is the second case of subserosal intramural ectopic pregnancy to be reported and the first in a subserosal area of adenomyosis. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
33. Ultrasound diagnosis of intramural pregnancy
- Author
-
Xi-juan Guo, Xue-song Han, Xian-chao Kong, Litao Sun, and Na-na Liu
- Subjects
medicine.medical_specialty ,Pregnancy ,030219 obstetrics & reproductive medicine ,Ectopic pregnancy ,Obstetrics ,business.industry ,Intramural pregnancy ,Gestational sac ,Ultrasound ,Myometrium ,Obstetrics and Gynecology ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Transvaginal ultrasound ,medicine.anatomical_structure ,medicine ,Differential diagnosis ,business - Abstract
Intramural pregnancy is a rare type of ectopic pregnancy, where the gestational sac is implanted inside the myometrium instead of the endometrial and fallopian tubes. Preoperative diagnosis remains very difficult. Ultrasonic findings vary according to the anatomical location or duration of pregnancy. In this study, we summarized the ultrasonic characteristics of intramural pregnancy by assessing three cases. We also propose a set of ultrasonic characteristics to facilitate differential diagnosis between intramural pregnancy and other types of ectopic pregnancy.
- Published
- 2017
34. Management of Intramural Pregnancy by Hysteroscopic Surgery
- Author
-
Yugang Chi, Boping Yang, Jing Tang, Li Li, Suzhen Ran, and Da Wei Zhu
- Subjects
medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Hysterectomy ,Ectopic pregnancy ,business.industry ,Intramural pregnancy ,medicine.medical_treatment ,Open surgery ,Obstetrics and Gynecology ,medicine.disease ,Hysteroscopic surgery ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Invasive surgery ,medicine ,business - Abstract
Intramural pregnancy is one of the rarest types of ectopic pregnancy. Surgery for intramural pregnancy could include excision or hysterectomy by laparoscopic or open surgery, we proposed a new treatment for intramural pregnancy to reduce the trauma of the patient. Hysteroscopic surgery will be a most minimally invasive surgery.
- Published
- 2019
35. Intramural pregnancy after in vitro fertilization and embryo transfer: A case report.
- Author
-
Xie QJ, Li X, Ni DY, Ji H, Zhao C, and Ling XF
- Abstract
Background: Intramural pregnancy is a rare type of ectopic pregnancy, which is diagnosed by transvaginal ultrasound and magnetic resonance imaging. Management strategies vary depending on the site of the pregnancy, the gestational age and the desire to maintain fertility. The incidence of intramural pregnancy in assisted reproductive technology is higher than that in natural pregnancy., Case Summary: We present a case of intramural pregnancy after in vitro fertilization and elective single embryo transfer following salpingectomy. The patient was completely asymptomatic and her serum β-human chorionic gonadotropin level increased from 290 mIU/mL to 1759 mIU/mL. Three-dimensional transvaginal ultrasound indicated a heterogeneous echogenic mass arising from the uterine fundus which was surrounded by myometrium and a slender and extremely hypoechoic area stretching to the uterine cavity which was thought to be a fistulous tract. Therefore, we considered a diagnosis of intramural pregnancy and laparoscopic surgery was conducted at 7 wk gestation., Conclusion: Early diagnosis and treatment of intramural pregnancy is significant for maintaining fertility., Competing Interests: Conflict-of-interest statement: All authors have no conflicts of interest to declare., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
36. Diagnostics and treatment of ectopic intramural pregnancy: a clinical case
- Author
-
I.V. Barinova, Yu.I. Sopova, S. N. Lysenko, A.A. Koval, A.A. Fedorov, M. A. Chechneva, A.A. Popov, and A.G. Bespalova
- Subjects
medicine.medical_specialty ,Obstetrics ,business.industry ,Intramural pregnancy ,medicine ,Obstetrics and Gynecology ,Clinical case ,business - Published
- 2020
37. Successful Management of Heterotopic Intramural Pregnancy Leading to a Live Birth of the Intrauterine Pregnancy
- Author
-
Jiangtao Lyu, Wenjie Sun, and Yi Lin
- Subjects
Adult ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Cesarean Section ,business.industry ,Obstetrics ,Intramural pregnancy ,Obstetrics and Gynecology ,Prenatal Care ,Embryo Transfer ,Intrauterine pregnancy ,Ultrasonography, Prenatal ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Humans ,Medicine ,Female ,Laparoscopy ,Pregnancy, Tubal ,030212 general & internal medicine ,business ,Live birth ,Live Birth ,Pregnancy, Heterotopic - Published
- 2018
38. Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy.
- Author
-
Chen X, Gao L, Yu H, Liu M, Kong S, and Li S
- Abstract
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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Chen, Gao, Yu, Liu, Kong and Li.)
- Published
- 2021
- Full Text
- View/download PDF
39. Ectopic Pregnancy in Uncommon Implantation Sites: Intramural Pregnancy and Rudimentary Horn Pregnancy
- Author
-
Fan Yu, Yi Wang, and Li-Qin Zeng
- Subjects
Gynecology ,medicine.medical_specialty ,Ectopic pregnancy ,business.industry ,Obstetrics ,Intramural pregnancy ,Optimal treatment ,Obstetrics and Gynecology ,Case Report ,medicine.disease ,lcsh:Gynecology and obstetrics ,Rudimentary horn pregnancy ,medicine.anatomical_structure ,medicine ,business ,lcsh:RG1-991 ,Fallopian tube - Abstract
Ectopic pregnancy is commonly located in the fallopian tube. Nevertheless, two unusual types of ectopic pregnancy, intramural pregnancy and rudimentary horn pregnancy, seriously threaten maternal life. The diagnosis and treatment of these unusual implantation sites present a clinical challenge. In this study, we illustrated the two unusual types of ectopic pregnancy and summarized the current data regarding diagnosis and optimal treatment from our experience.
- Published
- 2015
40. EP28.29: Intramural pregnancy: a case report
- Author
-
Y. Ouyang, Y. Mao, Xia Li, J. Xiao, and Q. Wu
- Subjects
medicine.medical_specialty ,Reproductive Medicine ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Intramural pregnancy ,Obstetrics and Gynecology ,Medicine ,Radiology, Nuclear Medicine and imaging ,General Medicine ,business - Published
- 2019
41. Diagnosis and management of intramural ectopic pregnancy
- Author
-
A. Jamil, Davor Jurkovic, Neil J. Sebire, Maria Memtsa, and Eric Jauniaux
- Subjects
Pregnancy ,medicine.medical_specialty ,Radiological and Ultrasound Technology ,Ectopic pregnancy ,Obstetrics ,business.industry ,Intramural pregnancy ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,medicine.disease ,Natural history ,Reproductive Medicine ,medicine ,Etiology ,Radiology, Nuclear Medicine and imaging ,Presentation (obstetrics) ,Differential diagnosis ,business - Abstract
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.
- Published
- 2013
42. Atypischer myometraner Flüssigkeitsverhalt in graviditate – intramurale Schwangerschaft oder degeneriertes Myom?
- Author
-
Nause Sl, K. Diedrich, Andreas Schröer, and Jan Weichert
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Intramural pregnancy ,Maternity and Midwifery ,Pediatrics, Perinatology and Child Health ,Obstetrics and Gynecology ,Medicine ,Fluid accumulation ,business - Abstract
Im Rahmen dieser Kasuistik soll der Fall einer Schwangeren mit einem suspekten Flussigkeitsverhalt im Myometrium der Uterusvorderwand berichtet und diskutiert werden. Der initiale Verdacht einer seltenen intramuralen Schwangerschaftsanlage konnte trotz relativer Terminunsicherheit in der 4+5. SSW mit der Darstellung einer intracavitaren Fruhschwangerschaft nicht bestatigt werden. Nach 2-maliger Punktion der Flussigkeitsretention und der Verdachtsdiagnose eines degenerierten Myom(-Konglomerats) zeigte sich ein ansonsten unauffalliger Schwangerschaftsverlauf bei weiter grosenprogredienter myomatoser Raumforderung der Vorderwand. Die in der vollendeten 38. SSW erfolgte Sectio und die postoperativen sonografischen Kontrollen bekraftigten den klinischen Eindruck eines Uterus myomatosus. Der vorliegende Fall zeigt, dass eine konservativ-exspektativen Vorgehensweise bei bestehendem Kinderwunsch moglich ist. In jedem Fall ist ein engmaschiges sonografisches Monitoring mit eingehender Beratung der Schwangeren zu fordern, insbesondere da die zwar seltenen, dennoch prognostisch deutlich ungunstigeren Differenzialdiagnosen (intramurale Schwangerschaft, sarkomatose Raumforderung) primar nicht sicher auszuschliesen sind.
- Published
- 2012
43. A very rare case of ectopic intramural pregnancy after IVF-ET
- Author
-
M. Konovalova and B. Bechev
- Subjects
Gynecology ,medicine.medical_specialty ,Reproductive Medicine ,business.industry ,Intramural pregnancy ,Rare case ,Obstetrics and Gynecology ,Medicine ,business - Published
- 2017
44. Intramural pregnancy: A case report.
- Author
-
Nees J, Faigle-Krehl G, Brucker J, Leucht D, Platzer LK, Flechtenmacher C, Sohn C, and Wallwiener M
- Abstract
A 24-year-old woman, who had undergone neither fertility treatment nor uterine surgery other than a cesarean section, presented with an intramural ectopic pregnancy. A laparotomy with uterine wedge resection including the embryonic tissue was performed. The postoperative course was uneventful, with falling βHCG levels. Two months after surgery she presented again with an intrauterine pregnancy., (© 2020 The Authors.)
- Published
- 2020
- Full Text
- View/download PDF
45. Sonographic Diagnosis of Intramural Pregnancy
- Author
-
Junmei Wang and Xing Xie
- Subjects
medicine.medical_specialty ,Text mining ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Intramural pregnancy ,Medicine ,Radiology, Nuclear Medicine and imaging ,business - Published
- 2013
46. Grossesse intra murale à propos d�un cas
- Author
-
Kofi-Mensa Savi de Tové, Olivier Biaou, Vicentia Boco, Kabibou Salifou, and Rachidi Sidi Imorou
- Subjects
Adult ,medicine.medical_specialty ,Case Report ,Pelvic Pain ,Grossesse extra-utérine, grossesse intra-murale, échographie, métrorragies ,métrorragies ,Pregnancy ,grossesse intra-murale ,medicine ,Humans ,Ultrasonography ,Gynecology ,lcsh:R5-920 ,Ectopic pregnancy ,business.industry ,Pelvic pain ,Intramural pregnancy ,lcsh:Public aspects of medicine ,echography ,Metrorrhagia ,échographie ,lcsh:RA1-1270 ,General Medicine ,medicine.disease ,eye diseases ,Pregnancy, Ectopic ,intramural pregnancy ,grossesse extra-utérine ,embryonic structures ,Myometrium ,ectopic pregnancy ,Female ,medicine.symptom ,business ,lcsh:Medicine (General) ,metrorrhagia - Abstract
La grossesse intra-murale est la variété la plus rare de grossesse extra-utérine. Il s'agit de la localisation de l'�uf dans l'épaisseur du myomètre. En cas de retard diagnostique, l'évolution peut être catastrophique avec rupture utérine et hémorragie cataclysmique. L'échographie permet dans certains cas un diagnostic pré opératoire. Les auteurs rapportent un cas survenu chez une patiente aux antécédents de curetage.
- Published
- 2015
47. Sonographic and MR findings in 2 cases of intramural pregnancy treated conservatively
- Author
-
Soo-Pyung Kim, In-Yang Park, Young Man Lee, Dae-Young Chung, Hee-Joong Lee, Hyun Sun Ko, Tai-Churl Park, and Jong-Chul Shin
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Ultrasonography, Prenatal ,Pregnancy ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Systemic methotrexate ,Nucleic Acid Synthesis Inhibitors ,Hysterectomy ,Pelvic MRI ,medicine.diagnostic_test ,business.industry ,Intramural pregnancy ,Magnetic resonance imaging ,medicine.disease ,Magnetic Resonance Imaging ,Pregnancy, Ectopic ,Uterine rupture ,Surgery ,Methotrexate ,Female ,business ,medicine.drug - Abstract
Intramural pregnancy is extremely rare and difficult to diagnose. Because of the high rate of uterine rupture in most cases, hysterectomy is often necessary. The optimal medical management for this condition is unknown. We report 2 cases of intramural pregnancy diagnosed by pelvic MRI and treated with systemic methotrexate.
- Published
- 2006
48. Eine 33-jährige II Gravida/I Para in der 11. SSW mit intramuraler Gravidität im Z. n. sekundärer Sectio
- Author
-
A. Hasenburg, S. Menge, and G. Gitsch
- Subjects
Gynecology ,medicine.medical_specialty ,Pregnancy ,Ectopic pregnancy ,Obstetrics ,business.industry ,Intramural pregnancy ,Uterus ,Obstetrics and Gynecology ,Maternal morbidity ,medicine.disease ,Uterine rupture ,First trimester ,medicine.anatomical_structure ,Maternity and Midwifery ,medicine ,Methotrexate ,business ,medicine.drug - Abstract
An intramural pregnancy is rare, difficult to diagnose, and is associated with a high rate of uterus ruptures with high maternal morbidity and mortality. An intramural pregnancy ofthe 11 th pregnancy week occurred in a 33-year-old gravida II/para I who had undergone a previous cesarean section two years ago. The pregnancy was located in the ventral wall of the uterus. After 4 weeks of treatment with methotrexat in escalating doses the pregnancy was terminated without complications by sectio parva. Conclusion: A previous cesarean section can increase the risk for an intramural pregnancy at the ventral wall of the uterus. If treatment with methotrexate is not successful at the end of the first trimester, a sectio parva should be discussed in view of the high risk of uterine rupture.
- Published
- 2005
49. Intramural Pregnancy Implanted Into a Myometrial Defect Caused by Curettage: Diagnosis With Transvaginal Sonography and Preconception and Postconception Magnetic Resonance Imaging
- Author
-
Tomonobu Kanasugi, Toru Sugiyama, Chizuko Isurugi, Masatoshi Murai, Akihiko Kikuchi, Hideyuki Chida, Rie Oyama, and Yuri Sasaki
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Dilatation and Curettage ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Transvaginal sonography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ultrasonography, Doppler, Color ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Intramural pregnancy ,Magnetic resonance imaging ,Magnetic Resonance Imaging ,Curettage ,Pregnancy, Ectopic ,Vagina ,Myometrium ,Female ,Radiology ,business - Published
- 2016
50. Intramural pregnancy in a previous cesarean section scar: a case report on conservative surgery
- Author
-
Miwa Adachi, Takafumi Kudo, Toshihiro Habara, Hideki Konishi, Soichi Noguchi, and Mikiya Nakatsuka
- Subjects
medicine.medical_specialty ,Pregnancy ,Ectopic pregnancy ,medicine.diagnostic_test ,business.industry ,Obstetrics ,Intramural pregnancy ,Previous cesarean section ,MEDLINE ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Surgery ,Medicine ,Ultrasonography ,business ,Laparoscopy ,Abdominal surgery - Published
- 2005
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