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Cai P, Zheng M, Wang Q, Wen Y, Chen H, Gong F, Lin G, Li X, Ouyang Y. Diagnosis and management of heterotopic intramural pregnancy after in vitro fertilization: an eight-case series. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024. [PMID: 39187241 DOI: 10.1055/a-2375-0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
PURPOSE To analyze the ultrasound characteristics, clinical management, and pregnancy outcomes of heterotopic intramural pregnancies (HIMPs) after embryo transfer. METHODS This was a retrospective observational study of women who were diagnosed with HIMPs. The ultrasound characteristics, clinical treatment, and pregnancy outcomes of patients with HIMPs were evaluated. RESULTS Eight women with HIMPs were included. Among them, 6 patients were diagnosed by transvaginal sonography, and 2 patients were misdiagnosed with heterotopic interstitial pregnancy. The diagnostic accuracy was 75% (6/8). Five patients with HIMPs were diagnosed at the time of the initial scan (5+6-6+3 weeks). An intramural gestational sac was observed in all 6 patients, and an embryo with cardiac activity was detected in one patient on the follow-up scans. Intrauterine pregnancies (IUPs) were revealed in all 6 patients, and embryo(s) with cardiac activity were observed in 5 patients at the time of the initial diagnosis or later. The patients receiving expectant treatment all presented with bagel signs, while patients with embryos with cardiac activity all underwent surgery. Among the 6 diagnosed women, 1 patient was initially treated medically, 4 were treated expectantly, and 1 was treated surgically. Among the 6 diagnosed patients, the IUPs of 5 patients resulted in live infants. CONCLUSION Single ET should be recommended to decrease the possibility of HIMP. An accurate diagnosis of HIMP was reached in most cases by detailed ultrasound early in the first trimester. Most IUPs of HIMPs seem to have good outcomes with timely and proper management. Expectant management might be a possible choice for nonviable intramural pregnancies.
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Affiliation(s)
- Pei Cai
- Imaging Department, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Mingxiang Zheng
- Imaging Department, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Qian Wang
- Imaging Department, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Yi Wen
- Imaging Department, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Hui Chen
- Endoscope center, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Fei Gong
- Reproductive center, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
- NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Sciences, Central South University, Changsha City, China
| | - Ge Lin
- Reproductive center, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
- NHC Key Laboratory of Human Stem Cell and Reproductive Engineering, School of Basic Medical Sciences, Central South University, Changsha City, China
| | - Xihong Li
- Imaging Department, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Yan Ouyang
- Imaging Department, Reproductive & Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Changsha City, China
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Ntafam CN, Sanusi-Musa I, Harris RD. Intramural ectopic pregnancy: An individual patient data systematic review. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100272. [PMID: 38269031 PMCID: PMC10805919 DOI: 10.1016/j.eurox.2023.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/26/2024] Open
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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Affiliation(s)
- Carnot N. Ntafam
- Detroit Medical Center Sinai-Grace Hospital, Detroit, MI 48235, USA
| | | | - Robert D. Harris
- Drexel University College of Medicine, Allegheny Health Network, Pittsburg, PA 15237, USA
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Cingiloglu P, Mooney S, Readman E, McNamara H, Choong S, Stone K, Ellett L. A Rare Case of Intramyometrial Pregnancy. J Minim Invasive Gynecol 2023; 30:861-863. [PMID: 37506877 DOI: 10.1016/j.jmig.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Pinar Cingiloglu
- Endosurgery Department (Drs. Cingiloglu, Mooney, Readman, McNamara, Choong, Stone, and Ellett), Mercy Hospital for Women, Heidelberg, Australia.
| | - Samantha Mooney
- Endosurgery Department (Drs. Cingiloglu, Mooney, Readman, McNamara, Choong, Stone, and Ellett), Mercy Hospital for Women, Heidelberg, Australia; Department of Obstetrics and Gynaecology (Drs. Mooney, and Readman), University of Melbourne, Parkville, Australia
| | - Emma Readman
- Endosurgery Department (Drs. Cingiloglu, Mooney, Readman, McNamara, Choong, Stone, and Ellett), Mercy Hospital for Women, Heidelberg, Australia; Department of Obstetrics and Gynaecology (Drs. Mooney, and Readman), University of Melbourne, Parkville, Australia
| | - Helen McNamara
- Endosurgery Department (Drs. Cingiloglu, Mooney, Readman, McNamara, Choong, Stone, and Ellett), Mercy Hospital for Women, Heidelberg, Australia
| | - Shawn Choong
- Endosurgery Department (Drs. Cingiloglu, Mooney, Readman, McNamara, Choong, Stone, and Ellett), Mercy Hospital for Women, Heidelberg, Australia
| | - Kate Stone
- Endosurgery Department (Drs. Cingiloglu, Mooney, Readman, McNamara, Choong, Stone, and Ellett), Mercy Hospital for Women, Heidelberg, Australia
| | - Lenore Ellett
- Endosurgery Department (Drs. Cingiloglu, Mooney, Readman, McNamara, Choong, Stone, and Ellett), Mercy Hospital for Women, Heidelberg, Australia
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Peng Y, Dai Y, Yu G, Jin P. High-intensity focused ultrasound ablation combined with systemic methotrexate treatment of intramural ectopic pregnancy: A case report. Medicine (Baltimore) 2022; 101:e31615. [PMID: 36401379 PMCID: PMC9678570 DOI: 10.1097/md.0000000000031615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE 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. PATIENT CONCERNS 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. DIAGNOSES IMP with adenomyosis. INTERVENTIONS High-intensity focused ultrasound (HIFU) treatment combined with systemic methotrexate (MTX) was performed to treat IMP, which would avoid operation and massive bleeding. OUTCOMES 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. LESSONS HIFU ablation combined with systemic MTX is effective for the treatment of IMP and is favorable for maintaining fertility.
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Affiliation(s)
- Yan Peng
- Department of Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
- *Correspondence: Yan Peng, Department of Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen 518000, Guangdong, China (e-mail: )
| | - Yu Dai
- Department of Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Guiyuan Yu
- Department of Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Ping Jin
- Department of Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China
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