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Case Reports
. 2025 Jul 20;14(14):5146.
doi: 10.3390/jcm14145146.

Ectopic Intramural Isthmic Pregnancy: Case Report

Eloisa Maria Mariani  1 , Diletta Guglielmi  1   2 , Paola Camponovo  1   2 , Erika Gambino  1   2 , Alessandra Inzoli  1   2 , Davide Leni  3 , Paolo Passoni  1 , Anna Locatelli  1   4
Affiliations
Case Reports

Ectopic Intramural Isthmic Pregnancy: Case Report

Eloisa Maria Mariani et al. J Clin Med. .

Abstract

Background/Objectives: Intramural pregnancy (IMP) is a rare type of ectopic pregnancy where the embryo implants within the uterine myometrium. This condition carries a high risk of massive hemorrhage, uterine rupture, and potentially life-threatening complications. Methods: We present a case of a 35-year-old patient who underwent in vitro fertilization (IVF) and was diagnosed with an IMP located in the back-isthmian portion of the uterus by ultrasound scan. Results: We performed a conservative treatment approach based on the gestational sac location and the patient's stable clinical condition and desire for future fertility. We first administered mifepristone 600 mg, followed by intracavitary methotrexate under ultrasound guidance. Although originally planned, a uterine artery embolization was not performed due to the evidence of bilateral anastomoses between the uterine and ovarian arteries. Progressive reabsorption of pregnancy was observed over the course of 8 months. Conclusions: Non-surgical management can be considered for IMP, thus allowing fertility preservation.

Keywords: Methotrexate (MTX); ectopic pregnancy (EP); fertility preservation; intramural pregnancy; uterine artery embolization (UAE).

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Ultrasound image before the start of treatment.
Figure 2
Figure 2
Beta-hCG trend. Red arrow indicates the day of mifepristone administration. Beta-hCG are expressed as mUI/mL.
Figure 3
Figure 3
Ultrasound image taken 17 days post-treatment.
Figure 4
Figure 4
Hysteroscopy after 3 months allows identification of the ostium of the conduit located in the posterior wall of the cervix.
See this image and copyright information in PMC

References

    1. Zhang Q.I., Xing X., Liu S., Xie X., Liu X., Qian F., Liu Y. Intramural ectopic pregnancy following pelvic adhesion: Case report and literature review. Arch. Gynecol. Obstet. 2019;300:1507–1520. doi: 10.1007/s00404-019-05379-3. - DOI - PubMed
    1. Ko H.S., Lee Y., Lee H.J., Park I.Y., Chung D.Y., Kim S.P., Park T.C., Shin J.C. Sonographic and MR findings in 2 cases of intramural pregnancy treated conservatively. J. Clin. Ultrasound. 2006;34:356–360. doi: 10.1002/jcu.20245. - DOI - PubMed
    1. Ntafam C.N., Sanusi-Musa I., Harris R.D. Intramural ectopic pregnancy: An individual patient data systematic review. Eur. J. Obstet. Gynecol. Reprod. Biol. X. 2024;21:100272. doi: 10.1016/j.eurox.2023.100272. - DOI - PMC - PubMed
    1. Chen X., Gao L., Yu H., Liu M., Kong S., Li S. Intramural ectopic pregnancy: Clinical characteristics, risk factors for uterine rupture and hysterectomy. Front. Med. 2021;8:769627. doi: 10.3389/fmed.2021.769627. - DOI - PMC - PubMed
    1. Shen Z., Liu C., Zhao L., Xu L., Peng B., Chen Z., Li X., Zhou J. Minimally-invasive management of intramural ectopic pregnancy: An eight-case series and literature review. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020;253:180–186. doi: 10.1016/j.ejogrb.2020.08.021. - DOI - PubMed

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