Intramural ectopic pregnancy: case report

Abstract

Background: Intramural ectopic pregnancy is pregnancy at the myometrial level without having a connection with the fallopian tubes or endometrial cavity, it is extremely rare; it represents less than 1% of all ectopic pregnancies. This type of pregnancy is difficult to diagnose, the diagnostic modalities include ultrasound, computed tomography and magnetic resonance imaging. Risk factors for this rare ectopic pregnancy have been described, including previous uterine trauma, adenomyosis, pelvic surgery, and in vitro fertilization. Clinical case description: A 32-year-old, first time pregnancy, arrives at the clinic with amenorrhea and a positive pregnancy test, an ultrasound was performed where a linear endometrium was observed without evidence of a gestational sac. Diagnostic impression: early pregnancy; she returned in 2 weeks, had a human chorionic gonadotropin beta fraction performed that reported 600 IU / ml. 2 days later the test is repeated and reports 5000 IU / ml. The patient begins with a colic pelvic pain of moderate intensity and transvaginal bleeding. A third pelvic ultrasound was performed, reporting a heterogeneous, irregular 1.63 by 1.50 image, compatible with a gestational sac containing an embryo without a heartbeat inside, corresponding to an intramural pregnancy and the presence of myoma. We decided to perform an exploratory laparotomy where a gestational sac and fibroid were removed, without complications. Conclusions: Imaging and laboratory studies are necessary for the diagnosis of intramural pregnancy, since it is highly unusual there is no consensus on its management, in this case the management was surgical.