Department of Obstetrics and Gynaecology, Faculty of Medicine, UKM Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia.
Department of Obstetrics and Gynaecology, Faculty of Medicine, UKM Medical Centre, Cheras 56000 Kuala Lumpur, Malaysia, Phone: +60391455949, Fax: +60391455672.
Horm Mol Biol Clin Investig. 2020 Mar 13;41(2):hmbci-2020-0001. doi: 10.1515/hmbci-2020-0001.
Intramyometrial ectopic pregnancy (IMEP) is a rare form of ectopic pregnancy. It is defined as a conceptus implanted within the myometrium and is completely surrounded by myometrium with clear separation from both the uterine cavity and tubes. IMEP possesses not only diagnostic but also therapeutic challenge. The majority of reported cases were managed by hysterectomy. Early management of unruptured IMEP using methotrexate may help to preserve fertility. We, for the first time, report a case of ruptured IMEP managed successfully using suction and curettage followed by Bakri balloon tamponade and avoiding hysterectomy. Post-procedure, the patient received two doses of intramuscular methotrexate 50 mg/m2 due to plateauing serial beta human chorionic gonadotropin (β-hCG) levels and subsequently achieved undetectable level 10 weeks post-methotrexate. She also had complete resolution of the ectopic intramyometrial mass.
子宫肌内异位妊娠（IMEP）是一种罕见的异位妊娠形式。它被定义为胚胎着床于子宫肌层内，并完全被子宫肌层所包围，与宫腔和输卵管均明确分隔。IMEP 不仅具有诊断挑战性，也具有治疗挑战性。大多数报道的病例都通过子宫切除术进行治疗。早期使用甲氨蝶呤治疗未破裂的 IMEP 可能有助于保留生育能力。我们首次报告了一例成功采用抽吸和刮宫术治疗破裂的 IMEP 的病例，随后采用 Bakri 球囊压迫止血，避免了子宫切除术。术后，由于连续β-人绒毛膜促性腺激素（β-hCG）水平呈平台期，患者接受了两次 50mg/m2 的肌内注射甲氨蝶呤治疗，随后在甲氨蝶呤治疗后 10 周达到不可检测水平。她的异位子宫肌内肿块也完全消退。
