Spontaneous intramural pregnancy- diagnosis and management
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We present a case of spontaneous intramural pregnancy.
A 28 year-old woman presented in our clinic because of continued vaginal bleeding (> 17 days). The patient had had no previous operations. Transvaginal ultrasound showed a cystic, vascularized structure on the posterior uterine wall. No intrauterine amniotic sac could be seen in spite of a ß-HCG value of 19.128 U/l, altogether suspicious for an ectopic pregnancy.
Hysteroscopy showed a normal uterine cavity covered with decidua and with no indication of an intracavitary pregnancy or changes in the region of the posterior uterine wall. Laparoscopy demonstrated a bulge of the perimetrium with marked hypervascularisation in the region of the median posterior uterine wall, suggesting an ectopic pregnancy. Laparotomy had to be performed due to suspected placenta tissue deep within the uterine wall and the marked bleeding. All pregnancy material was removed and the bleeding was coagulated. The post-operative course was normal and the ß-HCG value sank below the indicative level.
An intramural gravidity is a very rare occurrence. Early diagnosis and adequate surgical intervention are decisive if the uterus is to be preserved or serious complications such as rupture of the uterus are to be avoided.
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