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 |