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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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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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Xie QJ, Li X, Ni DY, Ji H, Zhao C, Ling XF. Intramural pregnancy after in vitro fertilization and embryo transfer: A case report. World J Clin Cases 2022; 10:2869-2875. [DOI: 10.12998/wjcc.v10.i9.2869] [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] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Qi-Jun Xie
- Department of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, Jiangsu Province, China
| | - Xin Li
- Department of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, Jiangsu Province, China
| | - Dan-Yu Ni
- Department of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, Jiangsu Province, China
| | - Hui Ji
- Department of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, Jiangsu Province, China
| | - Chun Zhao
- Department of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, Jiangsu Province, China
| | - Xiu-Feng Ling
- Department of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, Jiangsu Province, China
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Xie QJ, Li X, Ni DY, Ji H, Zhao C, Ling XF. Intramural pregnancy after in vitro fertilization and embryo transfer: A case report. World J Clin Cases 2022; 10:2871-2877. [PMID: 35434105 PMCID: PMC8968797 DOI: 10.12998/wjcc.v10.i9.2871] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/19/2022] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Qi-Jun Xie
- Department of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, Jiangsu Province, China
| | - Xin Li
- Department of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, Jiangsu Province, China
| | - Dan-Yu Ni
- Department of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, Jiangsu Province, China
| | - Hui Ji
- Department of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, Jiangsu Province, China
| | - Chun Zhao
- Department of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, Jiangsu Province, China
| | - Xiu-Feng Ling
- Department of Reproductive Medicine, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, Jiangsu Province, China
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Ovarian ectopic pregnancy misdiagnosed as gestational choriocarcinoma: A case report. Ann Med Surg (Lond) 2022; 73:103236. [PMID: 35079370 PMCID: PMC8767310 DOI: 10.1016/j.amsu.2021.103236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction and importance: Choriocarcinoma is a highly malignant epithelial tumor with often distant metastasis. The clinical presentation of choriocarcinoma depends upon extend of disease and location of metastasis. Case presentation A 35-year-old multiparous woman was presented with severe pelvic pain, fatigue and cough. She was diagnosed with positive pregnancy due to elevated B-hCG and hyperechoic mass in right adnexa. Clinical discussion Exploration surgery showed a larger mass on the right ovary. She was diagnosed with choriocarcinoma however CT scan showed metastasis of lungs, brain and pelvis. She underwent multiple session of chemotherapy, nonetheless, after 8 months, she passed away. Conclusion Timely diagnosis and prompt treatment of choriocarcinoma is necessary to prevent mortality and bad prognosis. It should be differentially diagnosed with all the types of pregnancies. Choriocarcinoma is a highly malignant epithelial tumor with often distant metastasis. A 35-year-old multiparous woman was presented with severe pelvic pain, fatigue and cough. She was diagnosed with positive pregnancy due to elevated B-hCG and hyperechoic mass in right adnexa. Timely diagnosis and prompt treatment of choriocarcinoma is necessary to prevent mortality and bad prognosis.
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Chen X, Gao L, Yu H, Liu M, Kong S, Li S. Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy. Front Med (Lausanne) 2021; 8:769627. [PMID: 34778327 PMCID: PMC8583088 DOI: 10.3389/fmed.2021.769627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/05/2021] [Indexed: 01/02/2023] Open
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.
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Affiliation(s)
- Xiaoran Chen
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Lingyun Gao
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Hongna Yu
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Meijuan Liu
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Shujun Kong
- Department of Obstetrics and Gynecology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Sijian Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Minimally-invasive management of intramural ectopic pregnancy: an eight-case series and literature review. Eur J Obstet Gynecol Reprod Biol 2020; 253:180-186. [PMID: 32871441 DOI: 10.1016/j.ejogrb.2020.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/04/2020] [Accepted: 08/21/2020] [Indexed: 01/05/2023]
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.
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8
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Liu Y, Wu Y. Intramyometrial pregnancy after cryopreserved embryo transfer: a case report. BMC Pregnancy Childbirth 2020; 20:90. [PMID: 32041575 PMCID: PMC7011315 DOI: 10.1186/s12884-020-2784-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/31/2020] [Indexed: 02/07/2023] Open
Abstract
Background Intramyometrial pregnancy is a rare subtype of ectopic pregnancy. The cases following IVF-ET were few reported in recent years. The etiological factors include previous uterine trauma like myomectomy, salpingectomy, dilatation and curettage, assisted reproductive technologies and adenomyosis. Early diagnosis is difficult to make due to its various manifestation. The medical treatment includes conservative management with surgical excision, aortic balloon occlusion, uterine artery embolization, MTX etc. Sometimes hysterectomy was performed due to delayed diagnosis. Case presentation In this article, we presented a case of a 28 years old woman who had cryopreserved embryo transfer with a history of right side salpingectomy. We suspected it a right adnexa ectopic pregnancy at the first place, especially the right fallopian interstitial or right uterus cornu due to ultrasonography and medical history. The product of conception was discovered embedded in the myometrium and protruding out from the right side of the posterior uterine wall, with seemingly no connection with uterine cavity nor fallopian tubes. The diagnosis of intramural pregnancy was made intraoperatively and validated after pathological report. The interventions were made early enough that exploratory laparoscopy, hysteroscopy and conservative surgical excision were successfully performed at 7 weeks’ gestation preserving the fertility. Conclusions It is important for clinicians to be aware of risk factors of intramural pregnancy and maintain an index of suspicion in ART treatment. Ultrasound and laparoscopy are essential managements for early diagnose which make conservative treatment possible and prevent life-threatening consequences.
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Affiliation(s)
- Yuan Liu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University School of Meidicine, Shanghai, China
| | - Yu Wu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University School of Meidicine, Shanghai, China.
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Zhang Q, Xing X, Liu S, Xie X, Liu X, Qian F, Liu Y. Intramural ectopic pregnancy following pelvic adhesion: case report and literature review. Arch Gynecol Obstet 2019; 300:1507-1520. [PMID: 31729562 DOI: 10.1007/s00404-019-05379-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/06/2019] [Indexed: 12/19/2022]
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.
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Affiliation(s)
- Qi Zhang
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiaoxiao Xing
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Shuiqing Liu
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiao Xie
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xia Liu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Feng Qian
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yanping Liu
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
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Liu D, Gu X, Liu F, Shi F, Yang M, Wu Q. Application of contrast-enhanced ultrasound for scar pregnancy cases misdiagnosed as other diseases. Clin Chim Acta 2019; 496:134-139. [PMID: 31173731 DOI: 10.1016/j.cca.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of utilizing contrast-enhanced ultrasound (CEUS) in scar pregnancies misdiagnosed by transvaginal ultrasound (TVS). METHODS CEUS was performed in three patients with clinically suspected abnormal pregnancy, and the diagnosis were inconclusive by TVS. Clinical manifestations and features of TVS and CEUS in these cases were analyzed. RESULTS Three cases included an intramural pregnancy (IMP) after hysteromyomectomy, and two mass-based cesarean scar pregnancy (CSP), the mass was caused by curettage and spontaneous abortion, respectively. In all these cases, early enhancement with high intensity was observed by CEUS at the site of implantation. Moreover, prominently enhanced signal was detected inside the mass, with or without peritrophoblastic ring. No enhancement was detected in clots or masses after effective treatment. CONCLUSION CEUS can be used as a supplementary method to diagnose scar pregnancy and evaluate the treatment efficacy, especially in cases with ambiguous results by TVS.
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Affiliation(s)
- Dongmei Liu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Xiaoning Gu
- Department of Ultrasound, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Fang Liu
- Department of Ultrasound, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Fuwen Shi
- Department of Ultrasound, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Min Yang
- Department of Ultrasound, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.
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Vagg D, Arsala L, Kathurusinghe S, Ang WC. Intramural Ectopic Pregnancy Following Myomectomy. J Investig Med High Impact Case Rep 2018; 6:2324709618790605. [PMID: 30046624 PMCID: PMC6056775 DOI: 10.1177/2324709618790605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/03/2018] [Accepted: 06/23/2018] [Indexed: 11/20/2022] Open
Abstract
Intramural pregnancy is a rare form of ectopic pregnancy with early diagnosis
essential for prevention of severe hemorrhage and uterine rupture. We report a
rare case of an intramural ectopic pregnancy at 12 weeks gestation in a woman 1
year post open myomectomy. Both transvaginal ultrasound and magnetic resonance
imaging were utilized as diagnostic aids in this case. The rare nature of this
clinical scenario and lack of guidelines for management made clinical decision
making difficult. Due to the size and location of the gestational sac,
hysterectomy was deemed to be the safest modality, and a midline laparotomy,
total abdominal hysterectomy, and bilateral salpingectomy was performed.
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Affiliation(s)
- Deanne Vagg
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lima Arsala
- Royal Women's Hospital, Parkville, Victoria, Australia
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