A rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch sutures
Abstract Background Intramural ectopic pregnancy is a rare form of ectopic pregnancy that occurs within the myometrium. It is challenging to diagnose it early because of its nonspecific clinical presentation, and there is no consensus or guideline on the optimal management among gynecologists. Case...
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | BMC Women's Health |
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| Online Access: | https://doi.org/10.1186/s12905-024-03027-w |
| _version_ | 1797219610282426368 |
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| author | Junmiao Xiang Fendang Chen Zhuhua Cai Ruru Bao |
| author_facet | Junmiao Xiang Fendang Chen Zhuhua Cai Ruru Bao |
| author_sort | Junmiao Xiang |
| collection | DOAJ |
| description | Abstract Background Intramural ectopic pregnancy is a rare form of ectopic pregnancy that occurs within the myometrium. It is challenging to diagnose it early because of its nonspecific clinical presentation, and there is no consensus or guideline on the optimal management among gynecologists. Case presentation We report a case of a 34-year-old woman who developed fundal intramural ectopic pregnancy after a previous caesarean section with B-Lynch suture. The B-Lynch suture was performed at 38 weeks of gestation for postpartum hemorrhage caused by refractory uterine atony about 8 years ago. Since then, the patient had oligomenorrhea. The diagnosis of intramural ectopic pregnancy was not confirmed by magnetic resonance imaging or ultrasound. An exploratory laparoscopy and hysteroscopy was performed to remove the gestational sac without significant bleeding. The surgery was successful and the patient recovered well. The patient was advised to monitor her β-HCG levels regularly until they returned to normal, and a follow-up pelvic ultrasound showed no complications. However, she has not been able to conceive or have an ectopic pregnancy so far. Conclusions This case illustrates the difficulty of diagnosing intramural ectopic pregnancy, especially when it is associated with previous uterine surgery and B-Lynch suture. It also demonstrates the feasibility and safety of laparoscopic surgery for treating complete IUP, especially when the gestational sac is located close to the uterine serosa. However, the risk of uterine rupture and hemorrhage should be considered, and the patient should be informed of the possible complications and alternatives. Gynecologists should be familiar with various management strategies and customize the treatment plan according to the patient’s clinical situation and preferences. |
| first_indexed | 2024-04-24T12:36:23Z |
| format | Article |
| id | doaj.art-98ec3f79939e412ebf61339e6fa17d0b |
| institution | Directory Open Access Journal |
| issn | 1472-6874 |
| language | English |
| last_indexed | 2024-04-24T12:36:23Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Women's Health |
| spelling | doaj.art-98ec3f79939e412ebf61339e6fa17d0b2024-04-07T11:29:07ZengBMCBMC Women's Health1472-68742024-04-012411610.1186/s12905-024-03027-wA rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch suturesJunmiao Xiang0Fendang Chen1Zhuhua Cai2Ruru Bao3Department of Gynecology, Ruian People’s HospitalDepartment of Gynecology, Ruian People’s HospitalDepartment of Gynecology, Ruian People’s HospitalDepartment of Ultrasonography, Ruian People’s HospitalAbstract Background Intramural ectopic pregnancy is a rare form of ectopic pregnancy that occurs within the myometrium. It is challenging to diagnose it early because of its nonspecific clinical presentation, and there is no consensus or guideline on the optimal management among gynecologists. Case presentation We report a case of a 34-year-old woman who developed fundal intramural ectopic pregnancy after a previous caesarean section with B-Lynch suture. The B-Lynch suture was performed at 38 weeks of gestation for postpartum hemorrhage caused by refractory uterine atony about 8 years ago. Since then, the patient had oligomenorrhea. The diagnosis of intramural ectopic pregnancy was not confirmed by magnetic resonance imaging or ultrasound. An exploratory laparoscopy and hysteroscopy was performed to remove the gestational sac without significant bleeding. The surgery was successful and the patient recovered well. The patient was advised to monitor her β-HCG levels regularly until they returned to normal, and a follow-up pelvic ultrasound showed no complications. However, she has not been able to conceive or have an ectopic pregnancy so far. Conclusions This case illustrates the difficulty of diagnosing intramural ectopic pregnancy, especially when it is associated with previous uterine surgery and B-Lynch suture. It also demonstrates the feasibility and safety of laparoscopic surgery for treating complete IUP, especially when the gestational sac is located close to the uterine serosa. However, the risk of uterine rupture and hemorrhage should be considered, and the patient should be informed of the possible complications and alternatives. Gynecologists should be familiar with various management strategies and customize the treatment plan according to the patient’s clinical situation and preferences.https://doi.org/10.1186/s12905-024-03027-wIntramural ectopic pregnancyLaparoscopyB-Lynch suturesHysteroscopyIntrauterine adhesionsCase report |
| spellingShingle | Junmiao Xiang Fendang Chen Zhuhua Cai Ruru Bao A rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch sutures BMC Women's Health Intramural ectopic pregnancy Laparoscopy B-Lynch sutures Hysteroscopy Intrauterine adhesions Case report |
| title | A rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch sutures |
| title_full | A rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch sutures |
| title_fullStr | A rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch sutures |
| title_full_unstemmed | A rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch sutures |
| title_short | A rare case of fundal intramural ectopic pregnancy associated with previous B-Lynch sutures |
| title_sort | rare case of fundal intramural ectopic pregnancy associated with previous b lynch sutures |
| topic | Intramural ectopic pregnancy Laparoscopy B-Lynch sutures Hysteroscopy Intrauterine adhesions Case report |
| url | https://doi.org/10.1186/s12905-024-03027-w |
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