Intra-myometrial pregnancy-A rare site of ectopic pregnancy

Abstract

A 35-year-old G2 P1 L1 lady presented with amenorrhea of 7 weeks and mild lower abdominal pain. No prior history of abortion or dilatation and curettage. Urine pregnancy test was positive and early antenatal ultrasound was advised. Transvaginal sonography was performed which revealed a gestational sac in the myometrium close to serosa (Figure 1A). Fetal pole was seen within the sac with good fetal cardiac activity (Figure 1B). MRI pelvis was done for better delineation of the sac. MRI (Figure 2A and 2C) showed gestational sac with hypointense fetal pole in the anterior myometrium as revealed on USG. MRI (Figure 2B) revealed additional finding of T2 curvilinear hyperintense tract which was seen extending from the endometrial cavity to gestational sac. Bilateral adnexa were normal and there was no free fluid in pelvis. USG and MRI features were suggestive of intramyometrial pregnancy. In view of location of gestational sac in the myometrium close to serosa with high risk of rupture, wedge resection of myometrium was performed (Figure 2D). Patient was discharged on 5th post-operative day with no complications. Abstract