The rarest localization of ectopic pregnancy - Intramyometrial!!
This is a rare form of ectopic pregnancy that makes a diagnostic and therapeutic challenge. The pathological definition of an intramyometrial pregnancy refers to a conceptus implanting within the myometrium and separated from both the uterine cavity and tubes as well as surrounded by myometrium. If misdiagnosed, it can cause a uterine rupture and become life-threatening condition. Here we got a case of intramyometrial pregnancy in twin pregnancy following IVF with spontaneous abortion of the first twin At 9 weeks of gestation. The 10 weeks scan showed a normal fetus which was described to be highly localized in the uterus but the diagnosis of intramyometrial pregnancy was not suspected. The patient was admitted at 14 weeks of gestation with pelvic pain, hemorrhage, and shock. Ultrasound showed an exocentric gestational sac with cardiac activity and suspected rupture of intramyometrial pregnancy. The patient was immediately operated. Surgical exploration showed a partial rupture of the right lateral uterine wall with a conceptus adherent to myometrium without communication with the uterine cavity. The conceptus was removed and the uterine wall closed with a 2 layers of resorbable sutures. Followup was free of complications and a postoperative hysterosalpingogram (3 months after the surgery) demonstrated no uterine parietal defect nether uterine diverticulitis. The patient had become spontaneously pregnant 11 months after the surgery and is actually at 32 weeks of gestation.
Very interesting! Is it possible to re-implant the fetus within the uterus after discovery of a condition like this?
Hate how they refer to the fetus as “conceptus” sounds dirty or wrong. Fetus is the more appropriate medical term. Only critique. Tragic but interesting none the less.
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