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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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2
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Guo Y, Feng T, Du X. A detective of intramural ectopic pregnancy: The use of pituitrin under hysteroscopy combined with laparoscopy. Medicine (Baltimore) 2023; 102:e33379. [PMID: 36961158 PMCID: PMC10036029 DOI: 10.1097/md.0000000000033379] [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: 02/06/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
RATIONALE Intramural pregnancy is a rare ectopic pregnancy in which the gestational sac is implanted between the muscle walls. Due to the lack of specific clinical manifestations, it is easy to misdiagnose or miss them. If it is allowed to get worse, the uterus will burst, and there will be a lot of bleeding in the later stages, which could lead to the death of the patient. PATIENT CONCERNS The patient had no history of uterine surgery, embryo transplantation, or any other operations. She complained of having abdominal distention and swelling of the waist but no vaginal bleeding or lower abdomen discomfort. DIAGNOSES According to her transvaginal ultrasonography, we highly suspected ectopic pregnancy. Hysteroscopy combined with laparoscopy is an effective treatment option that can prevent life-threatening problems. During the surgery, pituitrin helped find the gestational sac, and the pathology report confirmed that it was an intramural pregnancy. INTERVENTIONS Hysteroscopy combined with laparoscopy is an effective treatment option that can prevent life-threatening problems. During the surgery, we used pituitrin to help find the gestational sac. The use of pituitrin can minimize bleeding during a uterine operation and indicate the location of an intramural pregnancy, helping surgeons to complete the operation successfully. OUTCOMES The patient recovered quickly and was discharged on the 4th day after surgery, with a significant decrease in human chorionic gonadotrophin (HCG) levels from 14,792.26 mIU/mL before surgery to 1071.40 mIU/mL at discharge. During the follow up, her HCG level dropped to 50.90 mIU/mL on the 14th day after the surgery. She monitored the HCG levels intermittently until they fell within the normal range. LESSONS Intramural pregnancy is a rare form of ectopic pregnancy, and it is difficult to diagnose early on. This may result in uterine rupture or even life-threatening hemorrhage. If an intramural pregnancy is suspected in early pregnancy, hysteroscopy combined with laparoscopy is advised, and if necessary, low-dose posterior pituitary hormone can enhance uterine contractions and better reveal the position of the gestational sac within the uterine wall.
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Affiliation(s)
- Yanchao Guo
- Department of Obstetrics and Gynecology, Medical College of Wuhan University of Science and Technology, Wuhan, Hubei Province, China
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei Province, China
| | - Tongfu Feng
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei Province, China
| | - Xin Du
- Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei Province, China
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3
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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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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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Scibetta EW, Han CS. Ultrasound in Early Pregnancy: Viability, Unknown Locations, and Ectopic Pregnancies. Obstet Gynecol Clin North Am 2020; 46:783-795. [PMID: 31677754 DOI: 10.1016/j.ogc.2019.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Ultrasound is essential in the evaluation and management of pregnancies of unknown location. Differential diagnoses include early pregnancy loss, pregnancy of unknown location, and ectopic pregnancies. Both transabdominal and transvaginal routes should be available, in addition to physical examination, for complete evaluation. Diagnostic criteria for early pregnancy loss have expanded in recent years to ensure false positive results do not lead to inappropriate evacuation of desired pregnancies.
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Affiliation(s)
- Emily W Scibetta
- Department of Obstetrics and Gynecology, Harbor-UCLA, 1000 W Carson St, Torrance, CA 90509, USA.
| | - Christina S Han
- Division of Maternal-Fetal Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, Room 27-139 CHS, Los Angeles, CA 90095-1740, USA; Center for Fetal Medicine and Women's Ultrasound, 6310 San Vicente Boulevard, Suite 520, Los Angeles, CA 90048, USA
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7
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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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8
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Yang B, Zhu D, Tang J, Ran S, Li L, Chi Y. Management of Intramural Pregnancy by Hysteroscopic Surgery. J Minim Invasive Gynecol 2019; 27:995-996. [PMID: 31520724 DOI: 10.1016/j.jmig.2019.09.768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/05/2019] [Accepted: 09/07/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Boping Yang
- Department of Gynecology (Drs. Yang and Chi)
| | - DaWei Zhu
- Department of Obstetrics and Gynecology, Daping Hospital, Third Military Medical University (Drs. Zhu and Li), Chongqing, China
| | - Jing Tang
- Department of Ultrasonography (Drs. Tang, and Ran), Chongqing Maternal and Child Health Hospital
| | - Suzhen Ran
- Department of Ultrasonography (Drs. Tang, and Ran), Chongqing Maternal and Child Health Hospital
| | - Li Li
- Department of Obstetrics and Gynecology, Daping Hospital, Third Military Medical University (Drs. Zhu and Li), Chongqing, China
| | - Yugang Chi
- Department of Gynecology (Drs. Yang and Chi).
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9
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Su S, Chavan D, Song K, Chi D, Zhang G, Deng X, Li L, Kong B. Distinguishing between intramural pregnancy and choriocarcinoma: A case report. Oncol Lett 2017; 13:2129-2132. [PMID: 28454372 PMCID: PMC5403629 DOI: 10.3892/ol.2017.5737] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/06/2016] [Indexed: 12/17/2022] Open
Abstract
Intramural pregnancy is a rare type of ectopic pregnancy with an unclear etiology. It may be associated with uterine wall injury and/or abnormal uterine conditions, such as adenomyosis, in certain cases. In the present report, a case of intramural pregnancy associated with adenomyosis is discussed. The patient was 34 years old and presented with amenorrhea for 40 days. Ultrasonography and magnetic resonance imaging revealed a mixed echogenic mass located within the posterior wall of the uterine fundus with abundant blood flow. In addition, the patient's β-human chorionic gonadotropin levels were markedly elevated; however, these levels demonstrated a declining tendency. Clinically, it was difficult to distinguish the diagnosis of the case between intramural pregnancy and choriocarcinoma. Following initial treatment with methotrexate-based chemotherapy, a laparotomy was performed to confirm the diagnosis and excise the lesion. Pathological analysis confirmed a diagnosis of intramural pregnancy and adenomyosis within the uterine wall. The results of the present case report suggest that surgical intervention should be the first action performed when intramural pregnancy is suspected, in order to confirm the diagnosis and treat the disease.
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Affiliation(s)
- Shan Su
- Department of Obstetrics and Gynecology, Qilu Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China.,Reproductive Medicine Center, Qilu Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China
| | - Devendra Chavan
- Department of Obstetrics and Gynecology, Qilu Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China
| | - Kun Song
- Department of Obstetrics and Gynecology, Qilu Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China
| | - Dennis Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | - Guiyu Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiaohui Deng
- Department of Obstetrics and Gynecology, Qilu Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China.,Reproductive Medicine Center, Qilu Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China
| | - Li Li
- Department of Obstetrics and Gynecology, Qilu Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China.,Reproductive Medicine Center, Qilu Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital Affiliated to Shandong University, Jinan, Shandong 250012, P.R. China
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Chida H, Kikuchi A, Murai M, Sasaki Y, Kanasugi T, Isurugi C, Oyama R, Sugiyama T. Intramural Pregnancy Implanted Into a Myometrial Defect Caused by Curettage: Diagnosis With Transvaginal Sonography and Preconception and Postconception Magnetic Resonance Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2066-2067. [PMID: 27574126 DOI: 10.7863/ultra.15.11071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Hideyuki Chida
- Department of Obstetrics and Gynecology Iwate Medical University School of Medicine Morioka, Japan
| | - Akihiko Kikuchi
- Department of Obstetrics and Gynecology Iwate Medical University School of Medicine Morioka, Japan
| | - Masatoshi Murai
- Department of Obstetrics and Gynecology Iwate Medical University School of Medicine Morioka, Japan
| | - Yuri Sasaki
- Department of Obstetrics and Gynecology Iwate Medical University School of Medicine Morioka, Japan
| | - Tomonobu Kanasugi
- Department of Obstetrics and Gynecology Iwate Medical University School of Medicine Morioka, Japan
| | - Chizuko Isurugi
- Department of Obstetrics and Gynecology Iwate Medical University School of Medicine Morioka, Japan
| | - Rie Oyama
- Department of Obstetrics and Gynecology Iwate Medical University School of Medicine Morioka, Japan
| | - Toru Sugiyama
- Department of Obstetrics and Gynecology Iwate Medical University School of Medicine Morioka, Japan
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Kolanska K, Cohen J, Zanini-Grandon AS, Belghiti J, Bornes M, Daraï E. [How I do… in situ methotrexate injection in the treatment of intramyometrial pregnancy]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2016; 44:435-436. [PMID: 27426691 DOI: 10.1016/j.gyobfe.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/09/2016] [Indexed: 06/06/2023]
Affiliation(s)
- K Kolanska
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
| | - J Cohen
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France.
| | - A S Zanini-Grandon
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
| | - J Belghiti
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
| | - M Bornes
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
| | - E Daraï
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
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12
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Cohen J, Kolanska K, Zanini-Grandon AS, Belghiti J, Thomassin-Naggara I, Bazot M, Bornes M, Daraï E. Treatment of Intramyometrial Pregnancy by In Situ Injection of Methotrexate. J Minim Invasive Gynecol 2016; 24:335-337. [PMID: 27241811 DOI: 10.1016/j.jmig.2016.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 11/18/2022]
Abstract
Intramyometrial ectopic pregnancies are rare, and various management modalities have been described. We report a patient with intramyometrial pregnancy who was successfully treated by in situ injection of methotrexate (MTX) after the failure of 2 intramuscular injections of MTX. We emphasize the difficult management of intramyometrial pregnancy and show that in situ MTX injection may be indicated for this particular type of ectopic pregnancy.
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Affiliation(s)
- Jonathan Cohen
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France.
| | - Kamila Kolanska
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Anne-Sophie Zanini-Grandon
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Jeremie Belghiti
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Marc Bazot
- Department of Radiology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Marie Bornes
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Emile Daraï
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC6-UPMC, Centre Expert en Endométriose (C3E), UMR S938, Université Pierre et Marie Curie Paris 6, Paris, France
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Watson KM, Horadagoda NU, Piripi SA. Dachshund bitch with severe uterine adhesions and intramural uterine foreign material as an incidental ovariohysterectomy finding. Aust Vet J 2016; 94:24-6. [PMID: 26814158 DOI: 10.1111/avj.12387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 04/07/2015] [Accepted: 05/11/2015] [Indexed: 11/29/2022]
Affiliation(s)
- K M Watson
- University of Sydney Faculty of Veterinary Science, Small Animal General Practice, Camden, NSW, Australia
| | - N U Horadagoda
- University of Sydney Faculty of Veterinary Science, Small Animal General Practice, Camden, NSW, Australia
| | - S A Piripi
- University of Sydney Faculty of Veterinary Science, Small Animal General Practice, Camden, NSW, Australia
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Chukus A, Tirada N, Restrepo R, Reddy NI. Uncommon Implantation Sites of Ectopic Pregnancy: Thinking beyond the Complex Adnexal Mass. Radiographics 2015; 35:946-59. [PMID: 25860721 DOI: 10.1148/rg.2015140202] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Uncommon implantation sites of ectopic pregnancy include the cervix, interstitial segment of the fallopian tube, scar from a prior cesarean delivery, uterine myometrium, ovary, and peritoneal cavity. Heterotopic and twin ectopic pregnancies are other rare manifestations. Ultrasonography (US) plays a central role in diagnosis of uncommon ectopic pregnancies. US features of an interstitial ectopic pregnancy include an echogenic interstitial line and abnormal bulging of the myometrial contour. A gestational sac that is located below the internal os of the cervix and that contains an embryo with a fetal heartbeat is indicative of a cervical ectopic pregnancy. In a cesarean scar ectopic pregnancy, the gestational sac is implanted in the anterior lower uterine segment at the site of the cesarean scar, with thinning of the myometrium seen anterior to the gestational sac. An intramural gestational sac implants in the uterine myometrium, separate from the uterine cavity and fallopian tubes. In an ovarian ectopic pregnancy, a gestational sac with a thick hyperechoic circumferential rim is located in or on the ovarian parenchyma. An intraperitoneal gestational sac is present in an abdominal ectopic pregnancy. Intra- and extrauterine gestational sacs are seen in a heterotopic pregnancy. Two adnexal heartbeats suggest a live twin ectopic pregnancy. Recognition of the specific US features will help radiologists diagnose these uncommon types of ectopic pregnancy.
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Affiliation(s)
- Anjeza Chukus
- From the Department of Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140 (A.C., N.I.R.); Department of Radiology, George Washington University School of Medicine, Washington, DC (N.T.); and Department of Radiology, Miami Children's Hospital, Miami, Fla (R.R.)
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