A case of successful normal full term delivery after intramural pregnancy excision in heterotypic intramural pregnancy / 대한산부인과학회지

Heterotypic pregnancy occurs when there coexist intrauterine and extrauterine (or ectopic) pregnancy and it is very rare. But the incidence of heterotypic pregnancy has been increased due to the rise in pelvic endometriosis, pelvic inflammatory disease (PID), surgery of fallopian tubes and assisted reproductive technologies (ART), such as in vitro fertilization and embryo transfer (IVF-ET). In heterotypic pregnancy, extrauterine gestations are usually implanted in a fallopian tube, ovary, uterine cervix, uterine cornus or peritoneum but rarely in muscle layer of uterus (intramural pregnancy). It is difficult to preserve intrauterine pregnancy because of the risk of uterine rupture after excision of intramural pregnancy. We have experienced a heterotypic intramural pregnancy after IVF-ET which was successfully treated by excision of intramural pregnancy while maintaining the viability of the intrauterine pregnancy. So, we report this case with brief review of literatures.

Two cases of intramural pregnancy managed successfully through laparoscopic surgery / 대한산부인과학회지

We experienced two cases of the intramural pregnancy, the rarest form of ectopic pregnancy and a life-threatening condition, that were successfully managed through different techniques of uterus-preserving laparoscopic surgery, thus we present these cases with a review of the literature.

A Case of Treatment with Methotrexate Local Injection on Intramural Pregnancy within a Previous Cesarean Scar / 대한산부인과학회지

Intramural pregnancy on a cesarean section scar is one of the rarest forms of ectopic pregnancy that may cause serious complications such as uterine rupture and massive bleeding. The common treatment in the past was laparotomy, but today early diagnosis is available thanks to the development of image diagnostic technology and, as a consequence, cases of less invasive conservative management are reported. Using vaginal ultrasonography and MRI, we made an early diagnosis on a case of intramural pregnancy on the scar of a previous cesarean section. We injected methotrexate locally into the gestational sac, and the intramural pregnancy was completely cured. Thus, here we report this case with a brief review of relevant literature.

A Case of Conservative Management of Ectopic Pregnancy Embedded in the Myometrium of Previous Cesarean Section Scar / 대한주산의학회잡지

Intramural pregnancy, implanted in the previous cesarean section scar, is one of the rare and dangerous forms of ectopic pregnancies, because a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, or significant maternal morbidity, due to severe hemorrhaging. With the development of transvaginal ultrasound and MRI, early diagnosis and conservative treatment of intramural pregnancy is possible. For young patients who wish to maintain their fertility, an earlier diagnosis and more conservative treatment are desirable. We experienced a case of intramural pregnancy developed in the previous cesarean section scar and successfully treated it with conservative management. So we report this case with a brief review of literature.

Conservative Medical Treatment of Intramural Pregnancies Diagnosed by MRI: Two Case Reports / 대한주산의학회잡지

Intramural pregnancy is one of the rare forms of ectopic pregnancy and the optimal treatment is unknown. We describe two cases of intramural pregnancy treated with systemic methotrexate, which were diagnosed by pelvic MRI. Medical treatment with methotrexate may be a conservative treatment alternative for intramural pregnancies.

Intramural Pregnancy after in vitro Fertilization and Embryo Transfer / 대한불임학회지

Intramural pregnancy is an unusual ectopic gestation located within the uterine wall, completely surrounded by myometrium and separate from the uterine cavity, fallopian tube, or round ligament. It is known to be difficult to diagnose, and associated with a high rate of uterine rupture. We report a case of intramural pregnancy in which early diagnosis was made and successful treatment was done by dilatation and curettage. Diagnostic laparoscopy confirmed the absence of uterine rupture during the procedure. Therefore, conservation of fertility can be possible with early diagnosis of intramural pregnancy. To our knowledge, this is the first case report of intramural pregnancy following IVF-ET in Korea.

Clinical Analysis of Intramural Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The goal of this article is to analyze the clinical characteristics of intramural pregnancy through the review of currently available 36 case reports. METHODS: A comprehensive computer literature search was performed in MEDLINE and EMBASE database from 1966 to 2003. And domestic literature search was preformed in KSOG database. After data collection, we reviewed and analyzed meaningful clinical variables of each case report. RESULTS: 36 articles were included. The age at diagnosis ranged from 20 to 41 years old, and the mean age was 31.2 years (S.D.:5.6). The gestational period at diagnosis ranged from 6th to 30th weeks, more than half of the cases occurred from 6th to 10th week (58.3%). Significant risk factors were history of dilatation and curettage (47.2%) and history of cesarean section (25.0%). Common clinical symptoms and signs were vague abdominal pain (58.3%) and vaginal bleeding (54.2%) in unruptured case, and sudden onset of severe abdominal pain (100%) and muscle guarding (75.0%) in ruptured case. The preoperative diagnostic accuracy was 0% before introduction of ultrasonography into the clinical practice, 48.2% after ultrasonography was available. Of 36 patients, 27 patients (75.0%) were treated with laparotomy, and 5 patients (13.8%) were treated with methotrexate. Survival outcome of fetus was very poor. Only in 1 case, the pregnancy persisted beyond the 30th week, and the fetus survived after cesarean hysterectomy. CONCLUSION: With the advanced diagnostic tools and close monitoring of patients, we can improve the diagnostic accuracy and clinical outcome of intramural pregnancy.

Conservative Management of Intramural Pregnancy Implanting in The Cesarean Section Scar / 대한산부인과학회잡지

OBJECTIVE: To evaluate of safety and effectiveness of conservative treatment of previous cesarean section scar pregnancy. METHODS: Ten patients with previous cesarean section scar pregnancy were treated systemic methotrexate or intra-amnionic methotrexate injection. After treatment, patients were measured for the levels of serum beta-hCG and underwent ultrasound. According to the results, additional dose of methotrexate or curettage were done. Serum beta-hCG and ultrasound were checked several times until the level of serum beta-hCG and the finding of ultrasound had been normalized. RESULTS: Two patients showed normal serum beta-hCG levels and ultrasound findings after intra-amnionic methotrexate injection only. Two patients showed normal serum beta-hCG levels and ultrasound findings after systemic methotrexate/folinic acid therapy followed by dilatation and curettage. Six patients showed normal serum beta-hCG levels and ultrasound findings after intra-amnionic methotrexate injection followed dilatation and curettage. Two patients were transfused due to massive bleeding and other patients were not experienced severe complications. CONCLUSION: These results suggest that systemic or intra-amnionic methotrexate therapy with or without dilatation and curettage is safe and effective as a primary therapy for intramural pregnancy implanting in the cesarean section scar.

A Case of Intramural Pregnancy in Uterus / 대한산부인과학회잡지

To our knowledge, implantation into the uterine muscle wall is one of the rare form of ectopic pregnancy, with only 16 cases reported until 1995. The early diagnosis depends upon the sonographic finding of intramural gestational sac-like growth and persistent high beta human chorionic gonadotropin (beta-hCG) levels after dilatation and curettage. But, nobody can't exclude intramural pregnancy in case that associated with adenomyosis in uterus in spite of negative beta-hCG. Hsieh et al. and Dousias et al. mentioned 2 cases of such situation with negative beta-hCG result. And confirmative diagnosis depends upon the pathologic finding for specimen obtained from laparoscopic or explorative hysterotomy. The authors have experienced one case of intramural pregnancy in uterus and report our case with a brief review of literature.

A Case of Successful Treatment with Methotrexate Injection on Intramural Pregnancy Embedded in the Myometrium of Previous Cesarean Section Scar / 대한산부인과학회잡지

Intramural pregnancy implanting in the previous cesarean section scar is one of the rarest form of an ectopic pregnancy and probably the most dangerous form because of its risk of rupture and hemorrhage. For its sonographic diagnosis, the gestational sac should be in the anterior wall of uterine isthmic portion, there should be no myometrium between bladder and gestational sac, and it should be verified that uterine cavity and cervix should be isolated from gestational sac. For young patients who wish to maintain their fertility, an earlier diagnosis and more conservative treatment are desirable. We have recently experienced a case of intramural pregnancy implanting in the scar of cesarean section, treated with systemic methotrexate injection. So, we report this case with a brief review of the literature.

A Case of Ectopic Pregnancy within a Previous Cesarean Scar / 대한산부인과학회잡지

Implantation of a gestational sac within a previous cesarean scar is the rarest form of ectopic pregnancy. A delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity due to severe hemorrhage. As developing of transvaginal ultrasound and MRI, early diagnosis could be made and conservative treatment could be possible. We have recently experienced a case of intramural pregnancy implanting in the scar of cesarean section, and enabled the successful treatment to preserve the patient's reproductive capability.

Successful Conservative Chemotherapy for Intramural Pregnancy: A Case Report / 대한산부인과학회잡지

More than 95% of ectopic pregnancies involve the fallopian tubes. Other sites of ectopic implantation are less frequent, and a pregnancy in the myometrium is extremely rare. Few cases are reported in the literature which satisfy the criteria required for the diagnosis of intramural ectopic pregnancy, and unequivocal diagnosis without extirpation of the ruptured uterus is difficult. Most of ruptured cases have been treated with surgical modality including hysterectomy, and for more conservative management early detection is important. MRI is a useful, noninvasive and confirmative imaging modality for the detection of intramural pregnancy. Chemotherapy with methotrexate is an effective treatment that allows preservation of reproductive potential in selected case. We described a case of unruptured intramural pregnancy diagnosed with MRI and successfully treated with methotrexate. Theoretical and possible pathophysiologic derangements of this rare pregnancy- related disorder are also reviewed.

A Case of Intramural Pregnancy / 대한산부인과학회잡지

Intramural pregnancy is among the rarest forms of ectopic pregnancy. Since it has been first reported by Doederlein in 1913, 37 cases were reported in worldwide literatures. The pathologic criteria required for intramural pregnancy is that the product of conception is completely surrounded by uterine musculature and is separated from the uterine cavity and the fallopian tube or round ligament. Because of the difficult early diagnosis of intramural pregnancy, most cases were found after the onset of complications such as uterine rupture, shock and hemoperitoneum. Early detection of intramural pregnancy with the use of transvaginal ultrasonogram is important, and MRI is a useful, noninvasive imaging modality. We report a case of successful conservative chemotherapy for a intramural pregnancy with brief review of literatures.

A Case of Intramural Pregnancy / 대한산부인과학회잡지

Intramural pregnancy is one of the rarest forms of ectopic pregnancy. The pathologic diagnosis of the intramural ectopic pregnancy requires that the myometrium surrounds the products of conception separated from the endometrial cavity or fallopian tubes. Because the early diagnosis is very difficult, most cases are found after the onset of complications such as a uterine rupture or hemoperitoneum. The previous histories of curettage, cesarean section, myomectomy, salpingectomy and manual removal of the placenta are known as possible etiology of the intramural pregnancy. We have recently experienced a case of intramural pregnancy after 10 times of curettages and are reporting with a brief review of the literatures.

A Case of Intramural Pregnancy

Intramural pregnancy is a rare variant of ectopic pregnancy, which was first reported in 1924 by Perli, and only 21 cases have been reported in the literature. The pathologic diagnosis of an intramural pregnancy can be made by the myometrium surrounding the products of conception that separate it from the endometrial cavity or fallopian tubes. Recent development of radiologic ultrasonography and radioimmunoassay of the beta-subunit of human chorionic gonadotropin has markedly enhanced the ability to diagnose intramural pregnancy during very early gestation. Many reports have noted that there would be possible relationships between the intramural pregnancy and prior uterine traumatic factor-curettage, cesarean section, myomectomy, salpingectomy, and manual removal of the placenta. We experienced a 28-year-old female patient with amenorrhea for 7 weeks and sudden vaginal spotting. She underwent dilatation and curettage at 4 weeks of gestation. We report this case with a brief review of the literature.

A case of Intramural Pregnancy following currettage , treated with Laparoscopic exicision and MTX / 대한산부인과학회잡지

Intramural pregnancy is one of the rarest form of ectopic pregnancy that only 20 cases have been reported in the world so far. Pathologically, the location of the gestational sac is completely isolated from the uterine cavity and entirely surrounded by myometrium without any contact of endometrium. Many reports noted that there would be possible relationship between the intramural pregnancy and prior uterine traumatic factor- curettage, cesarean section, myomectomy, salpingectomy, and manual removal of the placenta and so on. We have recently experienced a case of intramural pregnancy following curettage, managed completely by the laparoscopic excision and additive single dose intramuscular MTX treatment. So, we report this case with a brief review of the literature.

A Case of Intramural Pregancy / 대한산부인과학회잡지

Intramural implantation is among the rarest forms of ectopic pregnancy.Since the first description by Perli, 21 cases were reported in worldwide literatures.The pathologic criteria required for intramural pregnancy is that the product of conception is completely surrounded by uterine musculature and is separated from the uterine cavity and the fallopian tube or round ligament.The previous history of uterine injury or adenomyosis is known as possible etiology of intramural implantation. Because the early diagnosis is very difficult, most cases is found after onset of complication such as a uterine rupture or hemoperitoneum. We have recently experienced a case of intramural pregnancy diagnosed and treated by laparoscopy in a 9 weeks gestation nulliparous woman without previous history of uterine injury or disease, and report with a brief review of literatures.