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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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Xiang J, Chen F, Cai Z, Bao R. A rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch sutures. BMC Womens Health 2024; 24:210. [PMID: 38566024 PMCID: PMC10986008 DOI: 10.1186/s12905-024-03027-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Intramural ectopic pregnancy is a rare form of ectopic pregnancy that occurs within the myometrium. It is challenging to diagnose it early because of its nonspecific clinical presentation, and there is no consensus or guideline on the optimal management among gynecologists. CASE PRESENTATION We report a case of a 34-year-old woman who developed fundal intramural ectopic pregnancy after a previous caesarean section with B-Lynch suture. The B-Lynch suture was performed at 38 weeks of gestation for postpartum hemorrhage caused by refractory uterine atony about 8 years ago. Since then, the patient had oligomenorrhea. The diagnosis of intramural ectopic pregnancy was not confirmed by magnetic resonance imaging or ultrasound. An exploratory laparoscopy and hysteroscopy was performed to remove the gestational sac without significant bleeding. The surgery was successful and the patient recovered well. The patient was advised to monitor her β-HCG levels regularly until they returned to normal, and a follow-up pelvic ultrasound showed no complications. However, she has not been able to conceive or have an ectopic pregnancy so far. CONCLUSIONS This case illustrates the difficulty of diagnosing intramural ectopic pregnancy, especially when it is associated with previous uterine surgery and B-Lynch suture. It also demonstrates the feasibility and safety of laparoscopic surgery for treating complete IUP, especially when the gestational sac is located close to the uterine serosa. However, the risk of uterine rupture and hemorrhage should be considered, and the patient should be informed of the possible complications and alternatives. Gynecologists should be familiar with various management strategies and customize the treatment plan according to the patient's clinical situation and preferences.
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Affiliation(s)
- Junmiao Xiang
- Department of Gynecology, Ruian People's Hospital, Wangsong Road, Ruian, 325000, Zhejiang, China.
| | - Fendang Chen
- Department of Gynecology, Ruian People's Hospital, Wangsong Road, Ruian, 325000, Zhejiang, China
| | - Zhuhua Cai
- Department of Gynecology, Ruian People's Hospital, Wangsong Road, Ruian, 325000, Zhejiang, China
| | - Ruru Bao
- Department of Ultrasonography, Ruian People's Hospital, Wangsong Road, Ruian, 325000, Zhejiang, China
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Kubo K, Fujikawa A, Mitoma T, Mishima S, Ohira A, Kirino S, Maki J, Eto E, Masuyama H. Total laparoscopic wedge resection for an intramural ectopic pregnancy using an intraoperative ultrasound system: A case report. Asian J Endosc Surg 2024; 17:e13303. [PMID: 38488404 DOI: 10.1111/ases.13303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/21/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
Intramural pregnancy is a rare form of ectopic pregnancy, and the optimal treatment remains uncertain. We describe a 33-year-old woman (gravida 2, para 0) who visited our hospital with suspected ectopic pregnancy. The patient was asymptomatic and hemodynamically stable. Transvaginal ultrasonography revealed pregnancy at 6 weeks of gestation and a gestational sac and fetal heartbeat in the anterior muscular layer of the uterus, away from the endometrium. The fetal sac measured 26 mm. The serum human chorionic gonadotropin (hCG) level had increased to 27 655 mIU/mL. Accordingly, the patient was diagnosed with an intramural ectopic pregnancy and underwent total laparoscopic wedge resection using intraoperative ultrasonography. The postoperative course was uneventful, and she was discharged after 4 days. Her serum hCG level normalized at 26 days postoperatively. This case indicates that intraoperative laparoscopic ultrasonography seems viable for treating intramural pregnancies.
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Affiliation(s)
- Kotaro Kubo
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsushi Fujikawa
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomohiro Mitoma
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Sakurako Mishima
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Akiko Ohira
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Satoe Kirino
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jota Maki
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Eriko Eto
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Ouyang Y, Xiao J, Wang Q, Wen Y, Chen H, Gong F, Li X. Intramural twin pregnancy after in-vitro fertilization. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024. [PMID: 38441845 DOI: 10.1002/uog.27626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 08/31/2024]
Affiliation(s)
- Y Ouyang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Centre for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - J Xiao
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Centre for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Q Wang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Centre for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - Y Wen
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Centre for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - H Chen
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Centre for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - F Gong
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Centre for Reproduction and Genetics in Hunan Province, Changsha City, China
| | - X Li
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha City, China
- Clinical Research Centre for Reproduction and Genetics in Hunan Province, Changsha City, China
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Thanasa A, Thanasa E, Grapsidi V, Antoniou IR, Gerokostas EE, Kamaretsos E, Chasiotis A, Thanasas I. Interstitial Ectopic Pregnancy Associated With Painless and Severe Vaginal Bleeding: A Rare, Atypical Clinical Presentation. Cureus 2024; 16:e53225. [PMID: 38425637 PMCID: PMC10903376 DOI: 10.7759/cureus.53225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Interstitial ectopic pregnancy is rare (2%-4% of ectopic pregnancies). The atypical clinical presentation of interstitial ectopic pregnancy associated with massive vaginal bleeding is extremely rare and makes early preoperative diagnosis even more difficult. The presentation of our case concerns the early diagnosis and surgical treatment of a patient with an interstitial ectopic pregnancy without rupture, which presented atypically with painless, severe vaginal bleeding. A 27-year-old fourth-term pregnant woman presented with massive painless vaginal bleeding. Secondary amenorrhea was calculated at eight weeks and four days. Transvaginal ultrasound and transvaginal Doppler ultrasound combined with the quantification of beta-chorionic gonadotropin hormone raised the suspicion of interstitial ectopic pregnancy. Intraoperatively, the presence of a large swelling of the right horn of the uterus was established, and a wedge resection was performed with the removal of the corresponding fallopian tube. Three weeks after surgery, the serum beta-chorionic gonadotropin hormone value was zero. In this paper, the rarity of interstitial ectopic pregnancy, the difficulties related to early and correct preoperative diagnosis, and the selection of the appropriate available therapeutic procedures are emphasized, the correct application of which can significantly contribute to reducing the morbidity and mortality of these patients.
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Affiliation(s)
- Anna Thanasa
- Medicine, Department of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Efthymia Thanasa
- Medicine, Department of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Vasiliki Grapsidi
- Obstetrics and Gynecology, General Hospital in Trikala, Trikala, GRC
| | | | | | | | | | - Ioannis Thanasas
- Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
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Nijjar S, Bottomley C, Jauniaux E, Jurkovic D. Imaging in gynecological disease (25): clinical and ultrasound characteristics of intramural pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:279-289. [PMID: 37058401 DOI: 10.1002/uog.26219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 06/19/2023]
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.
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Affiliation(s)
- S Nijjar
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - C Bottomley
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - E Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - D Jurkovic
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK
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Washio K, Komatsu M, Tomimoto M, Uchida A, Sasagawa Y, Nishimoto M, Nagamata S, Yamasaki Y, Tanimura K, Terai Y. Uterine rupture in intramural ectopic pregnancy: A case report. Asian J Endosc Surg 2023. [PMID: 36608704 DOI: 10.1111/ases.13156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 01/08/2023]
Abstract
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. We report a rare case of intramural ectopic pregnancy. If a patient has a history of intrauterine surgery or myomectomy, the possibility of intramural pregnancy, although rare, should not be ruled out.
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Affiliation(s)
- Keiichi Washio
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Komatsu
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masako Tomimoto
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akiko Uchida
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuki Sasagawa
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masashi Nishimoto
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoshi Nagamata
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yui Yamasaki
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Tanimura
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
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Sun PP, Dong SY, Xie JL, Liu KK, Guo AP. Management of a uterine serosal heterotopic pregnancy after in vitro fertilization in a woman with bilateral salpingectomy: A case report and literature review. Medicine (Baltimore) 2022; 101:e32551. [PMID: 36595862 PMCID: PMC9794245 DOI: 10.1097/md.0000000000032551] [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: 12/29/2022] Open
Abstract
RATIONALE Heterotopic pregnancy (HP) is defined as the simultaneous presence of intrauterine pregnancy and ectopic pregnancy (EP). HP after bilateral salpingectomy is extremely rare and may lead to serious complications if it is misdiagnosed and untreated timely. Here, we presented the first reported case of uterine serosal HP in a woman after assisted reproductive technology with bilateral salpingectomy because of bilateral tubal ectopic pregnancy. PATIENT CONCERNS A 27-years-old pregnant woman after in vitro fertilization with bilateral salpingectomy complained of a sudden onset of unprovoked abdominal pain, which was persistent and dull. She denied vaginal bleeding. DIAGNOSES Serum beta-human chorionic gonadotropin levels are difficult to predict HP. Transvaginal ultrasonography demonstrated 1 gestational sac in the uterine cavity and 1 thick-walled cystic mass over the upper of the uterus, with a large amount of fluid in the Pouch of Douglas. Emergency laparotomy revealed a uterine serosal pregnancy combined with intrauterine pregnancy. INTERVENTIONS This patient was successfully managed via emergency laparotomy to remove residual tissue and repair the rupture of the uterine serosal pregnancy. OUTCOMES At postoperative 4 days, repeat transvaginal ultrosonography presented 1 intrauterine gestational sac with a visible fetal bud and cardiac tube pulsation. Now the patient recover well and is in an ongoing pregnancy. LESSONS It is noteworthy that HP/ectopic pregnancy is still not prevented after bilateral salpingectomy. In cases of multiple embryo transfer, even if intrauterine pregnancy has been established, it is important to rule out HP/ectopic pregnancy in time. Early diagnosis and early management can significantly improve clinical outcomes.
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Affiliation(s)
- Ping-Ping Sun
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
| | - Shu-Yi Dong
- The Reproductive Endocrinology Department of Gaomi Maternity and Child Care Hospital, Weifang, Shandong, China
| | - Jin-Long Xie
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
| | - Kun-Kun Liu
- The Reproductive Medicine Centre of Weifang People’s Hospital, Weifang, Shandong, China
| | - Ai-Ping Guo
- The Reproductive Endocrinology Department of Gaomi Maternity and Child Care Hospital, Weifang, Shandong, China
- * Correspondence: Ai-Ping Guo, The Reproductive Endocrinology Department of Gaomi Maternity and Child Care Hospital, No. 3188 Fenghuang Street of Gaomi, Weifang, Shandong Province 261000, China (e-mail: )
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Truong DP, Pham TH, Nguyen PN, Ho QN. Misdiagnosis of intramural ectopic pregnancy and invasive gestational trophoblastic disease on ultrasound: A challenging case at Tu Du Hospital in Vietnam in COVID-19 pandemic peak and mini-review of literature. Radiol Case Rep 2022; 17:4821-4827. [PMID: 36238215 PMCID: PMC9550589 DOI: 10.1016/j.radcr.2022.09.034] [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: 08/29/2022] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 11/07/2022] Open
Abstract
Differentiation between intramural ectopic pregnancy and molar ectopic pregnancy is very difficult because of their exceptional rarity. Herein, we present a misdiagnosed case of intramural pregnancy and invasive trophoblastic disease on ultrasound. A 45-year-old female patient was admitted to our tertiary referral hospital due to abdominal pain and unusual ultrasonography findings. Initially, a diagnosis of intramural ectopic pregnancy was identified based on transvaginal color Doppler ultrasonography, 3-dimensional ultrasound, and serial serum beta-human chorionic gonadotropin, thus the patient underwent laparotomy with hysterectomy. However, the histopathological endpoint showed an invasive trophoblastic disease. Clinically, this pathology should be included in the differential diagnosis of intramural ectopic pregnancy since an imaging scan remains quite unclear.
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Affiliation(s)
- Diem Phuong Truong
- Department of Obstetrics Bloc M, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Thanh Hai Pham
- Tu Du Clinical Research Unit, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Phuc Nhon Nguyen
- Tu Du Clinical Research Unit, Tu Du Hospital, Ho Chi Minh City, Vietnam,Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao ward, District 1, Ho Chi Minh City, 730000, Vietnam,Corresponding author.
| | - Quang Nhat Ho
- Department of Post-operative Care, Tu Du Hospital, Ho Chi Minh City, Vietnam
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