Clinical Analysis of Intramural Pregnancy / 대한산부인과학회잡지

ABSTRACT

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.