Ruptured Intramural Pregnancy with Myometrial Invasion Treat
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Introduction
Intramural pregnancy is the rarest form of ectopic pregnancy; it is characterized by a gestation within the uterine wall, completely surrounded by myometrium and separated from the uterine cavity and the fallopian tube. It has been first reported in 1913 by Doderlein et al. So far, less than 30 cases have been reported in the literature. This kind of pregnancy goes rarely further than 12 weeks' gestation. Diagnosis' establishment is difficult and is often made through surgical procedures or after extensive bleeding and uterine rupture occurring between 11 and 30 weeks' gestation which necessitates hysterectomy. The percentage of maternal mortality is approximately 2.5%. It may reflect uterine trauma, adenomyosis, and invasion of the uterine wall by placenta accreta or external migration and implantation of the embryo on the serosal surface of the uterus.

We report a case of a ruptured intramural pregnancy treated conservatively.

Case
A 38-year-old woman, gravida 5, para 1, abortion 2, with a history of secondary infertility and salpingectomy for an ectopic pregnancy, was referred for a suspicion of a pregnancy developing in a rudimentary cornua at 13 weeks' gestation. She was completely asymptomatic. Physical examination revealed stable vital signs while bimanual examination revealed an enlarged uterus with no adnexal masses. Transvaginal ultrasound revealed a gestational sac with a heartbeating fetus along with measurements corresponding to 13 weeks' gestation. The endometrial cavity was quite near in the right cornual region, but there was no evident communication between them. Both the endometrium and gestational sac appeared to be surrounded by myometrium. The diagnosis of intramural pregnancy was suspected and a Magnetic Resonance Imaging (MRI) was indicated. It revealed a gestational sac with a fetus developing inside the fundic uterine wall.....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335711/
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