Early detection and minimally invasive management of intramural pregnancy

Intramural pregnancy is a rare form of ectopic pregnancy, wherein the fetus is implanted within the myometrium, separate from the endometrial cavity. In the early reported cases, a diagnosis was only possible after an operation for uterine rupture; however, recent developments in ultrasonography and magnetic resonance imaging assist in early diagnosis. Early diagnosis prevents potential life-threatening hemorrhage and preserves fertility. Both medical therapy and surgery are used to treat intramural pregnancy: surgery is often performed via laparotomy and includes hysterectomy. Here, we report the first case of successfully combining hysteroscopy and laparoscopy in the early diagnosis and management of intramural pregnancy. Our experience reveals that the minimally invasive procedure is safe and effective in select cases where advanced endoscopic expertise is available.