Two cases of intramural pregnancy

Abstract

　Intramural pregnancy is a rare type of ectopic pregnancy, and early diagnosis is difficult. We herein report a case in which interstitial pregnancy was suspected during laparoscopy, but intramural pregnancy was eventually diagnosed. We also report another case of intramural pregnancy diagnosed a few months later that was suspected before operation.

　The first patient was a 38-year-old woman who conceived by in vitro fertilization. After spontaneous abortion and D&C, she became pregnant naturally. Transvaginal ultrasonography was performed, but no obvious gestational sac was visualized. The plasma beta human chorionic gonadotropin (hCG) level was 1,373 mIU/ml. We did not discover the pregnant lesion at diagnostic laparoscopy, but pelvic magnetic resonance imaging after the operation revealed a gestational sac in the uterine myometrium. With methotrexate therapy, the patient's hCG level steadily decreased.

　The second patient was a 36-year-old woman who conceived by artificial insemination. Ultrasound examination did not detect a fetal sac in the uterus at ６ weeks of gestation. Three days later, another ultrasound examination led us to suspect intramural pregnancy. Laparoscopic surgery was performed, and the ectopic pregnancy was resected. Histological examination confirmed chorionic villi within normal uterine muscular layer. Serum hCG levels promptly decreased to undetectable levels after the operation.

　We report two cases of intramural pregnancy that were successfully treated with pharmacotherapy or laparoscopic surgery.