Mariani Eloisa Maria, Guglielmi Diletta, Camponovo Paola, Gambino Erika, Inzoli Alessandra, Leni Davide, Passoni Paolo, Locatelli Anna
Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori Foundation, 20900 Monza, Italy.
Specialization School in Obstetrics and Gynecology, University of Milano-Bicocca, 20100 Monza, Italy.
J Clin Med. 2025 Jul 20;14(14):5146. doi: 10.3390/jcm14145146.
Intramural pregnancy (IMP) is a rare type of ectopic pregnancy where the embryo implants within the uterine myometrium. This condition carries a high risk of massive hemorrhage, uterine rupture, and potentially life-threatening complications. We present a case of a 35-year-old patient who underwent in vitro fertilization (IVF) and was diagnosed with an IMP located in the back-isthmian portion of the uterus by ultrasound scan. We performed a conservative treatment approach based on the gestational sac location and the patient's stable clinical condition and desire for future fertility. We first administered mifepristone 600 mg, followed by intracavitary methotrexate under ultrasound guidance. Although originally planned, a uterine artery embolization was not performed due to the evidence of bilateral anastomoses between the uterine and ovarian arteries. Progressive reabsorption of pregnancy was observed over the course of 8 months. Non-surgical management can be considered for IMP, thus allowing fertility preservation.
子宫肌层内妊娠（IMP）是一种罕见的异位妊娠类型，胚胎植入子宫肌层内。这种情况有大出血、子宫破裂以及潜在危及生命并发症的高风险。我们报告一例35岁的患者，其接受了体外受精（IVF），经超声扫描诊断为子宫峡部后壁的子宫肌层内妊娠。我们根据妊娠囊位置以及患者稳定的临床状况和对未来生育的愿望，采取了保守治疗方法。我们首先给予米非司酮600mg，随后在超声引导下进行宫腔内甲氨蝶呤注射。尽管最初有计划，但由于子宫动脉与卵巢动脉之间存在双侧吻合的证据，未进行子宫动脉栓塞术。在8个月的过程中观察到妊娠逐渐吸收。对于子宫肌层内妊娠可考虑非手术治疗，从而保留生育能力。
