Intramural pregnancy – Sonographic diagnosis and organ-preserving management – a case report

Aims: An intramural ectopic pregnancy is rare condition.This condition is associated with a high rate of an uterine rupture.

Case: A 31 yearold I-Grav,0-Para was transfered with an early pregnancy of unclear condition.She was suffering from abdominal pain.Next to an intramural myoma, which bulged into the uterine cavity at the right fundal region,the ultrasound scan revealed a structure like a gestational sac,which was located on the left side of the myometrium close to the left fundal region.It was surrounded by myometrium without having a connection to the uterine cavity.On the basis of the inadequate increase of beta-HCG as well as the suspected intramural pregnancy, the patient underwent a laparoscopy and a hysteroscopy. The operation confirmed the diagnosis of an intramural pregnancy located at the left side of the fundal region at the point of insertion of the left fallopian tube. As it was difficult to reach the location, the pregnancy could only be partially removed by means of a hysteroscopy under ultrasound supervision. Since the patient desired future childbearing, some remaining tissue was left in place.The operation was followed by an i.m. injection with 75mg methotrexate to medically treat the remaining tissue. The patient had an uncomplicated postoperative course, was checked out 5 days after the evacuation and treated as an outpatient with serial serum beta-HCG levels, which were regressive.

Conclusion: Although the occurence and the condition of an intramural pregnancy appears rarely,it has to be considered,particularly when ultrasound scans are performed and when sonographic signs point to it. Systematic treatment and its success allows for the possibility of continued fertility.