Intramyometrial pregnancy after hysteroscopic resection of retained products of conception – a case report


Authors: Hlinecká K.;  Lisá Z.;  Richtárová A.;  Kužel D.
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a VFN v Praze
Published in: Ceska Gynekol 2022; 87(1): 35-39
Category: Case Report
doi: 10.48095/cccg202235

Overview

Objective: The aim of this study is to report a case of intramyometrial gravidity after hysteroscopic resection of retained products of conception. Case report: We report the case of a 35-year old woman who presented at 7 weeks gestation with abdominal pain in the right iliac fossa, having had caesaren section 6 months ago. She underwent hysteroscopic resection of retained products of conception 6 weeks after casesarean section. The woman was submitted to two-and three-dimensional transvaginal ultrasound. Sonography revealed intramural ectopic pregnancy. Subsequently, we decided to perform a laparoscopic artery occlusion and removal of pregnancy with adequate multiple layer closure of the myometrial defect. Conclusion: Conservative laparoscopic surgery can be used successfully in patients with intramyometrial pregnancy. Even though the intramural pregnancy is a very rare type of ectopic pregnancy, it should be kept in mind by gynecologists because it can become a life-threatening condition. Early dia­gnosis helps to preserve future fertility.

Keywords:

hysteroscopy – intramyometrial gravidity – retained products of conception


Sources

1. Glass T, Smith P, Hodges R et al. Intramural pregnancy presenting in a patient with tuberous sclerosis. J Clin Ultrasound 2010; 38 (7): 393–396. doi: 10.1002/jcu.20721.

2. Kong L, Mao N, Shi Y et al. Dia­gnosis and management of intramural ectopic pregnancy in the second trimester-a case report. BJR Case Rep 2017; 3 (4): 20160095. doi: 10.1259/bjrcr.20160095.

3. Khalifa Y, Redgment CJ, Yazdani N et al. Intramural pregnancy following difficult embryo transfer. Hum Reprod 1994; 9 (12): 2427–2428. doi: 10.1093/oxfordjournals.humrep.a138463.

4. McGowan L. Intramural pregnancy. JAMA 1965; 192 (7): 637–639. doi: 10.1001/jama.1965.03080200055023.

5. Emge LA. The elusive adenomyosis of the uterus. Its historical past and its present state of recognition. Am J Obstet Gynecol 1962; 83: 1541–1563. doi: 10.1016/0002-9378 (62) 90170-9.

6. Choi DH, Kwon H, Kim YS et al. Intramural pregnancy associated with adenomyosis after in vitro fertilization and embryo transfer: a case report. J Reprod Med 2009; 54 (4): 255–258.

7. Azzis R. Adenomyosis: current perspectives. Obstet Gynecol Clin North Am 1989; 16 (1): 221–235.

8. Fait G, Goyert G, Sundareson A et al. Intramural pregnancy with fetal survival: case history and discussion of etiologic factors. Obstet Gynecol 1987; 70 (3 Pt 2): 472–474.

9. Falfoul A Jadoui A, Bellasfar M et al. Intramural pregnancy: a case report. J Gynecol Obstet Biol Reprod (Paris) 1992; 21 (6): 641–643.

10. Takeda A, Manabe S, Mitsui T et al. Management of patients with ectopic pregnancy with massive hemoperitoneum by laparoscopic surgery with intraoperative autologous blood transfusion. J Minim Invasive Gynecol 2006; 13 (1): 43–48. doi: 10.1016/j.jmig.2005.09.100.

11. Bachman EA, Barnhart K. Medical mana­gement of ectopic pregnancy: a comparison of regimens. Clin Obstet Gynecol 2012; 55 (2):  440–447. doi: 10.1097/GRF.0b013e3182510a73.

12. Zdeňková A, Fanta M, Calda P. Metotrexát v léčbě ektopické gravidity. Actual Gyn 2015; 7: 27–32.

13. Horák P, Mára M, Dundr P et al. Ischemizující metody léčby děložních myomů. Ceska Gynekol 2009; 74 (4): 262–268.

14. Holub Z. Laparoskopická okluze děložních tepen. In: Mára M (ed). Děložní myomy. Praha: Grada Publishing 2009.

15. Kubínová K, Mára M, Novotná M et al. Lapa­roskopická konzervativní léčba děložních myomů. Ceska Gynekol 2012; 77 (4): 326–330.

16. Muller V, Makhmadalieva M, Kogan I et al. Ectopic pregnancy following in vitro fertilization: meta-analysis and single-center experience during 6 years. Gynecol Endocrinol 2016; 32 (Suppl 2): 69–74. doi: 10.1080/09513590.2016.1232550.

17. Chen X, Gao L, Yu H et al. Intramural ectopic pregnancy: clinical characteristics, risk factors for uterine rupture and hysterectomy. Front Med (Lausanne) 2021; 8: 769627. doi: 10.3389/fmed.2021.769627.

18. Yoshigi J, Yashiro N, Kinoshita T et al. Dia­gnosis of ectopic pregnancy with MRI: efficacy of T2*-weighted imaging. Magn Reson Med Sci 2006; 5 (1): 25–32. doi: 10.2463/mrms.5.25.

19. Elías Estrada JC, Huerta Sáenz IH, Campos Del Castillo KB et al. Embarazo ectópico abdominal: reporte de dos casos. Rev Peru Ginecol Obstet 2021; 67 (1): 1–5. doi: 10.31403/rpgo.v67i2306.

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

21. Li S, Liu H, Li X et al. Transfemoral temporary aortic balloon occlusion in surgical treatment of second trimester intramural ectopic pregnancy. J Obstet Gynaecol Res 2016; 42 (6): 716–718. doi: 10.1111/jog.12968.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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