Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Asian J Endosc Surg. 2024 Apr;17(2):e13303. doi: 10.1111/ases.13303.
Intramural pregnancy is a rare form of ectopic pregnancy, and the optimal treatment remains uncertain. We describe a 33-year-old woman (gravida 2, para 0) who visited our hospital with suspected ectopic pregnancy. The patient was asymptomatic and hemodynamically stable. Transvaginal ultrasonography revealed pregnancy at 6 weeks of gestation and a gestational sac and fetal heartbeat in the anterior muscular layer of the uterus, away from the endometrium. The fetal sac measured 26 mm. The serum human chorionic gonadotropin (hCG) level had increased to 27 655 mIU/mL. Accordingly, the patient was diagnosed with an intramural ectopic pregnancy and underwent total laparoscopic wedge resection using intraoperative ultrasonography. The postoperative course was uneventful, and she was discharged after 4 days. Her serum hCG level normalized at 26 days postoperatively. This case indicates that intraoperative laparoscopic ultrasonography seems viable for treating intramural pregnancies.
子宫壁内妊娠是一种罕见的异位妊娠形式，其最佳治疗方法仍不确定。我们描述了一位 33 岁的女性（孕 2 产 0）因疑似异位妊娠就诊于我院。患者无症状，血流动力学稳定。经阴道超声检查显示妊娠 6 周，妊娠囊和胎心位于子宫前肌层，远离子宫内膜。孕囊大小为 26mm。血清人绒毛膜促性腺激素（hCG）水平升高至 27655mIU/mL。因此，患者被诊断为子宫壁内异位妊娠，并在术中超声引导下进行了全腹腔镜楔形切除术。术后过程顺利，患者在 4 天后出院。术后 26 天，她的血清 hCG 水平恢复正常。该病例表明，术中腹腔镜超声似乎可用于治疗子宫壁内妊娠。
