Top

Archives of Gynecology and Obstetrics

Published in:

01-12-2019 | Ultrasound | Review

Intramural ectopic pregnancy following pelvic adhesion: case report and literature review

Authors: Qi Zhang, Xiaoxiao Xing, Shuiqing Liu, Xiao Xie, Xia Liu, Feng Qian, Yanping Liu

Published in: Archives of Gynecology and Obstetrics | Issue 6/2019

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.

Ginsburg KA, Quereshi F, Thomas M, Snowman B (1989) Intramural ectopic pregnancy implanting in adenomyosis. Fertil Steril 51(2):354–356CrossRef

Bernstein HB, Thrall MM, Clark WB (2001) Expectant management of intramural ectopic pregnancy. Obstet Gynecol 97(5 Pt 2):826–827PubMed

Ong C, Su LL, Chia D, Choolani M, Biswas A (2010) Sonographic diagnosis and successful medical management of an intramural ectopic pregnancy. J Clin Ultrasound 38(6):320–324. https://doi.org/10.1002/jcu.20703 CrossRefPubMed

Ko HS, Lee Y, Lee HJ, Park IY, Chung DY, Kim SP et al (2006) Sonographic and MR findings in 2 cases of intramural pregnancy treated conservatively. J Clin Ultrasound 34(7):356–360. https://doi.org/10.1002/jcu.20245 CrossRefPubMed

Paul PG, Koshy AK, Thomas T (2006) Pregnancy outcomes following laparoscopic myomectomy and single-layer myometrial closure. Hum Reprod 21(12):3278–3281. https://doi.org/10.1093/humrep/del296 CrossRefPubMed

Lee GS, Hur SY, Kown I, Shin JC, Kim SP, Kim SJ (2005) Diagnosis of early intramural ectopic pregnancy. J Clin Ultrasound 33(4):190–192. https://doi.org/10.1002/jcu.20107 CrossRefPubMed

Hamilton CJ, Legarth J, Jaroudi KA (1992) Intramural pregnancy after in vitro fertilization and embryo transfer. Fertil Steril 57(1):215–217CrossRef

Lu HF, Sheu BC, Shih JC, Chang YL, Torng PL, Huang SC (1997) Intramural ectopic pregnancy. Sonographic picture and its relation with adenomyosis. Acta Obstet Gynecol Scand 76(9):886–889CrossRef

Ishiguro T, Yamawaki K, Chihara M, Nishikawa N, Enomoto T (2018) Myomectomy scar ectopic pregnancy following a cryopreserved embryo transfer. Reprod Med Biol 17(4):509–513. https://doi.org/10.1002/rmb2.12212 CrossRefPubMedPubMedCentral

10.

Vagg D, Arsala L, Kathurusinghe S, Ang WC (2018) Intramural ectopic pregnancy following myomectomy. J Investig Med High Impact Case Rep 6:2324709618790605. https://doi.org/10.1177/2324709618790605 CrossRefPubMedPubMedCentral

11.

Mahmoud OA, Mahmoud MZ (2017) A rare case of ectopic pregnancy in a caesarean section scar: a case report. BJR Case Rep 3(4):20170010. https://doi.org/10.1259/bjrcr.20170010 CrossRefPubMedPubMedCentral

12.

Su S, Chavan D, Song K, Chi D, Zhang G, Deng X et al (2017) Distinguishing between intramural pregnancy and choriocarcinoma: a case report. Oncol Lett 13(4):2129–2132. https://doi.org/10.3892/ol.2017.5737 CrossRefPubMedPubMedCentral

13.

Kong L, Mao N, Shi Y, Ma H, Xie H (2017) Diagnosis and management of intramural ectopic pregnancy in the second trimester-a case report. BJR Case Rep 3(4):20160095. https://doi.org/10.1259/bjrcr.20160095 CrossRefPubMedPubMedCentral

14.

Liu NN, Han XS, Guo XJ, Sun LT, Kong XC (2017) Ultrasound diagnosis of intramural pregnancy. J Obstet Gynaecol Res 43(6):1071–1075. https://doi.org/10.1111/jog.13322 CrossRefPubMed

15.

Chida H, Kikuchi A, Murai M, Sasaki Y, Kanasugi T, Isurugi C et al (2016) Intramural pregnancy implanted into a myometrial defect caused by curettage: diagnosis with transvaginal sonography and preconception and postconception magnetic resonance imaging. J Ultrasound Med 35(9):2066–2067. https://doi.org/10.7863/ultra.15.11071 CrossRefPubMed

16.

Li S, Liu H, Li X, Liu Z, Li Y, Li N (2016) Transfemoral temporary aortic balloon occlusion in surgical treatment of second trimester intramural ectopic pregnancy. J Obstet Gynaecol Res 42(6):716–718. https://doi.org/10.1111/jog.12968 CrossRefPubMed

17.

Wang Y, Yu F, Zeng LQ (2015) Ectopic pregnancy in uncommon implantation sites: intramural pregnancy and rudimentary horn pregnancy. Case Rep Obstet Gynecol 2015:536498. https://doi.org/10.1155/2015/536498 CrossRefPubMedPubMedCentral

18.

Liu Y, Nan F, Liu Z, Wei S, Liu Y, Zhao G et al (2014) Intramural pregnancy: a case report. Eur J Obstet Gynecol Reprod Biol 176:197–198. https://doi.org/10.1016/j.ejogrb.2014.02.027 CrossRefPubMed

19.

Bannon K, Fernandez C, Rojas D, Levine EM, Locher S (2013) Diagnosis and management of intramural ectopic pregnancy. J Minim Invasive Gynecol 20(5):697–700. https://doi.org/10.1016/j.jmig.2013.02.023 CrossRefPubMed

20.

Sharma A, Ojha R, Mondal S, Chattopadhyay S, Sengupta P (2013) Cervical intramural pregnancy: report of a rare case. Niger Med J 54(4):271–273. https://doi.org/10.4103/0300-1652.119670 CrossRefPubMedPubMedCentral

21.

Wang S, Dong Y, Meng X (2013) Intramural ectopic pregnancy: treatment using uterine artery embolization. J Minim Invasive Gynecol 20(2):241–243. https://doi.org/10.1016/j.jmig.2012.10.005 CrossRefPubMed

22.

Petit L, Lecointre C, Ducarme G (2013) Intramural ectopic pregnancy with live birth at 37 weeks of gestation. Arch Gynecol Obstet 287(3):613–614. https://doi.org/10.1007/s00404-012-2549-2 CrossRefPubMed

23.

YeKuang Chen X H, Si Y, Kong XC (2013) Preoperative diagnosis and successful laparoscopic management of intramural pregnancy: case report. Eur J Obstet Gynecol Reprod Biol 171(2):385–386. https://doi.org/10.1016/j.ejogrb.2013.09.013 CrossRefPubMed

24.

Memtsa M, Jamil A, Sebire N, Jauniaux E, Jurkovic D (2013) Diagnosis and management of intramural ectopic pregnancy. Ultrasound Obstet Gynecol 42(3):359–362. https://doi.org/10.1002/uog.12437 CrossRefPubMed

25.

Wu PJ, Han CM, Wang CJ, Lee CL (2013) Early detection and minimally invasive management of intramural pregnancy. J Minim Invasive Gynecol 20(1):123–126. https://doi.org/10.1016/j.jmig.2012.08.783 CrossRefPubMed

26.

Wang J, Xie X (2013) Sonographic diagnosis of intramural pregnancy. J Ultrasound Med 32(12):2215–2217. https://doi.org/10.7863/ultra.32.12.2215 CrossRefPubMed

27.

Kirk E, McDonald K, Rees J, Govind A (2013) Intramural ectopic pregnancy: a case and review of the literature. Eur J Obstet Gynecol Reprod Biol 168(2):129–133. https://doi.org/10.1016/j.ejogrb.2012.12.036 CrossRefPubMed

28.

McGowan L (1965) Intramural pregnancy. JAMA 192:637–638CrossRef

29.

Barnhart KT, Fay CA, Suescum M, Sammel MD, Appleby D, Shaunik A et al (2011) Clinical factors affecting the accuracy of ultrasonography in symptomatic first-trimester pregnancy. Obstet Gynecol 117(2 Pt 1):299–306. https://doi.org/10.1097/AOG.0b013e3182050ed0 CrossRefPubMed

30.

Condous G, Okaro E, Khalid A, Lu C, Van Huffel S, Timmerman D et al (2005) The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod 20(5):1404–1409. https://doi.org/10.1093/humrep/deh770 CrossRefPubMed

31.

Naftalin J, Jurkovic D (2009) The endometrial-myometrial junction: a fresh look at a busy crossing. Ultrasound Obstet Gynecol 34(1):1–11. https://doi.org/10.1002/uog.6432 CrossRefPubMed

32.

Timor-Tritsch IE, Yeh MN, Peisner DB, Lesser KB, Slavik TA (1989) The use of transvaginal ultrasonography in the diagnosis of ectopic pregnancy. Am J Obstet Gynecol 161(1):157–161CrossRef

33.

Jurkovic D, Bourne TH, Jauniaux E, Campbell S, Collins WP (1992) Transvaginal color Doppler study of blood flow in ectopic pregnancies. Fertil Steril 57(1):68–73CrossRef

34.

Chukus A, Tirada N, Restrepo R, Reddy NI (2015) Uncommon implantation sites of ectopic pregnancy: thinking beyond the complex adnexal mass. Radiographics 35(3):946–959. https://doi.org/10.1148/rg.2015140202 CrossRefPubMed

35.

Timor-Tritsch IE, Monteagudo A, Matera C, Veit CR (1992) Sonographic evolution of cornual pregnancies treated without surgery. Obstet Gynecol 79(6):1044–1049PubMed

36.

Ackerman TE, Levi CS, Dashefsky SM, Holt SC, Lindsay DJ (1993) Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology 189(1):83–87. https://doi.org/10.1148/radiology.189.1.8372223 CrossRefPubMed

37.

Malinowski A, Bates SK (2006) Semantics and pitfalls in the diagnosis of cornual/interstitial pregnancy. Fertil Steril 86(6):1764.e1711-1764. https://doi.org/10.1016/j.fertnstert.2006.03.073 CrossRef

38.

Jain KA (2005) Gestational trophoblastic disease: pictorial review. Ultrasound Q 21(4):245–253CrossRef

39.

Ramkrishna J, Kan GR, Reidy KL, Ang WC, Palma-Dias R (2018) Comparison of management regimens following ultrasound diagnosis of nontubal ectopic pregnancies: a retrospective cohort study. BJOG 125(5):567–575. https://doi.org/10.1111/1471-0528.14752 CrossRefPubMed

40.

Ha HK, Jung JK, Kang SJ, Koong SE, Kim SJ, Kim JY et al (1993) MR imaging in the diagnosis of rare forms of ectopic pregnancy. AJR Am J Roentgenol 160(6):1229–1232. https://doi.org/10.2214/ajr.160.6.8498223 CrossRefPubMed

41.

Sentilhes L, Bouet PE, Gromez A, Poilblanc M, Lefebvre-Lacoeuille C, Descamps P (2009) Successful expectant management for a cornual heterotopic pregnancy. Fertil Steril 91(3):934.e911-933. https://doi.org/10.1016/j.fertnstert.2008.09.072 CrossRef

42.

Yao M, Tulandi T (1997) Current status of surgical and nonsurgical management of ectopic pregnancy. Fertil Steril 67(3):421–433CrossRef

43.

Fylstra DL (2012) Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol 206(4):289–299. https://doi.org/10.1016/j.ajog.2011.10.857 CrossRefPubMed

44.

Murphy AA, Nager CW, Wujek JJ, Kettel LM, Torp VA, Chin HG (1992) Operative laparoscopy versus laparotomy for the management of ectopic pregnancy: a prospective trial. Fertil Steril 57(6):1180–1185CrossRef

45.

Sovik E, Stokkeland P, Storm BS, Asheim P, Bolas O (2012) The use of aortic occlusion balloon catheter without fluoroscopy for life-threatening post-partum haemorrhage. Acta Anaesthesiol Scand 56(3):388–393. https://doi.org/10.1111/j.1399-6576.2011.02611.x CrossRefPubMed

Title: Intramural ectopic pregnancy following pelvic adhesion: case report and literature review
Authors: Qi Zhang
Xiaoxiao Xing
Shuiqing Liu
Xiao Xie
Xia Liu
Feng Qian
Yanping Liu
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keywords: Ultrasound
Ectopic Pregnancy
Ultrasound
Amenorrhoea
Published in: Archives of Gynecology and Obstetrics / Issue 6/2019
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-019-05379-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intramural ectopic pregnancy following pelvic adhesion: case report and literature review

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2019

Endometrial thickness as a predictor of ectopic pregnancy in 1125 in vitro fertilization-embryo transfer cycles: a matched case–control study

Effect of embryo selection based morphokinetics on IVF/ICSI outcomes: evidence from a systematic review and meta-analysis of randomized controlled trials

Overweight and obesity do not determine worst prognosis in endometrioid endometrial carcinoma

Comparison of neovaginoplasty using acellular porcine small intestinal submucosa graft or Interceed in patients with Mayer–Rokitansky–Küster–Hauser syndrome

Hemorrhagic morbidity in placenta accreta spectrum with and without placenta previa

Serum zonulin level is not elevated in patients with polycystic ovary syndrome without metabolic syndrome