title: Diagnosis and management of intramural ectopic pregnancy.
abstract: Intramural pregnancy, a gestation completely surrounded by the myometrium located within the uterine wall with separation from the uterine cavity, is an extremely unusual form of pregnancy. Complications resulting from intramural pregnancy include inevitable uterine rupture with resultant hemorrhage and possible hysterectomy if diagnosis is not made early and treatment is not initiated. An asymptomatic patient was initially diagnosed with a missed abortion at approximately 6 weeks of gestation after a routine ultrasound. Suction curettage was performed approximately 1 month after the initial diagnosis. The pathology specimen failed to reveal placental villi. Ultimately, the diagnosis of intramural pregnancy was made via ultrasound and a computed tomography scan. She was treated with a single dose of systemically administered methotrexate. Over a period of 4 months, β-human chorionic gonadotropin levels trended downward; however, the intramural pregnancy failed to resolve completely, and a persistent mass remained. The intramural pregnancy was removed using the da Vinci laparoscopic procedure (Intuitive Surgical, Sunnyvale, CA). If the diagnosis of intramural ectopic pregnancy is made sufficiently early, conservative measures can be taken, which can preserve a patient's future fertility.
authors.affiliation: Advocate Illinois Masonic Medical Center, Chicago, Illinois. Electronic address: kimberly.bannon@advocatehealth.com.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Bannon
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernandez
authors.forename: David
authors.initials: D
authors.lastname: Rojas
authors.forename: Elliot M
authors.initials: EM
authors.lastname: Levine
authors.forename: Stephen
authors.initials: S
authors.lastname: Locher
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000328:Adult; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D010535:Laparoscopy; D008727:Methotrexate / Q000627:therapeutic use*; D009215:Myometrium / Q000000981:diagnostic imaging / Q000601:surgery*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate
keywords: Color Doppler sonography; Ectopic pregnancy; Intramural ectopic pregnancy