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Table 1 Therapies for intramyometrial pregnancies

From: Spontaneous intramyometrial pregnancy mimicking an intramural myoma: a diagnostic challenge

  Number of patients Past history Diagnosis Treatment Outcome
Ginsburg et al. [5] 1 Adenomyosis 16 week pregnancy with hemoperitoneum and suspected uterine rupture Laparotomic hysterectomy
Katano et al. [12] 1 1 D/C for a partial mole US and MRI: GS with 22-mm CRL + FHB (−) Laparoscopy: MTX injection into the GS + 2 US-guided injections of MTX HCG (−) on 19th POD, HSG: pooling of contrast medium in the region of intramyometrial pregnancy
Bernstein et al. [10] 1 1 D/C + 1 spontaneous abortion Transabdominal US: GS with a yolk sac Spontaneous HCG (−) on 10th POD, HSG: small endometrial polyp with a moderately arcuate uterus
Diagnostic laparoscopy
Lee et al. [15] 1 Right adnexectomy for torsion US: GS with CRL and yolk sac Laparotomic enucleation
Ko et al. [3] 1 5 D/C (last D/C 4 weeks before) US and MRI: GS in the posterior wall Alternating IM MTX and leucovorin for 8 days HCG (−) after 8 weeks
Park et al. [4] 1 Myomectomy by laparotomy + transfer of 3 embryos US: GS in subserosal region of the posterior wall with CRL and yolk sac Laparoscopy: incision, aspiration, and interrupted sutures HCG (−) on 14th POD, subsequent pregnancy after 4 frozen embryos transferred on 92nd POD + placental invasion of the myometrium
Ong et al. [1] 1 Bilateral endometriomas and adenomyosis US: GS + CRL 3 mm + FHB (+) US-guided intrafetal KCl and intra-amniotic MTX injections HCG (−) on 82nd POD
Leyder et al. [9] 1 Uterine artery embolization for symptomatic uterine fibroids + transfer of 2 embryos US and MRI Systemic MTX injection
Glass et al. [11] 1 Tuberous sclerosis US and MRI: GS without CRL, failure of US-guided curettage Laparoscopy + laparotomic enucleation due to hemoperitoneum and size of the mass
Nabeshima et al. [14] 1 Left salpingectomy for ectopic tubal pregnancy and 1 C/S US: GS + FHB (+) Laparoscopy: myometrial injection of vasopression + section with Harmonic® scalpel + excision of surrounding myometrium + running suture + fibrin glue HCG (−) on 14th POD, HSG: no change compared with before pregnancy
Present study 1 Spontaneous abortion without D/C US and MRI Laparoscopy: CO2 laser section + no excision of myometrium + 2-layer running suture Low HCG after first diagnostic laparoscopy, complete healing of the myometrium after second laparoscopy
Diagnostic laparoscopy
  1. D/C dilatation–curettage, US ultrasound, GS gestational sac, CRL crown-rump length, FHB fetal heartbeat, MTX methotrexate, POD postoperative day, HSG hysterosalpingography, C/S cesarean section, KCl potassium chloride