Background: Intramural pregnancy is a rare but potentially life-threatening condition. The condition remains unknown to many clinicians and sonographers. With the ever-increasing use of high-resolution ultrasound scanning, early diagnosis of the condition is now possible, provided that the condition is thought of. To our knowledge, this is the first reported case of intramural pregnancy treated with suction evacuation under laparoscopic guidance.
Case: A 28-year-old woman presented with history of vaginal bleeding early in her fourth pregnancy, having had 2 previous suction terminations of pregnancy and evacuation of retained products of conception for incomplete miscarriage at 8 weeks' gestation 2 months earlier. An ultrasound scan showed a complex mass in the left fundal region of the uterus, and the serum beta-human chorionic gonadotropin levels were grossly elevated. The patient was found to have an intramural hyperplastic pregnancy, treated with suction evacuation under laparoscopic guidance and systemic methotrexate therapy.
Conclusion: A macroscopic ostium led into the uterine cavity and made guided suction evacuation of the uterus possible. Early diagnosis can prevent a life-threatening situation and conserve reproductive function.
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