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Intramural ectopic pregnancy: An individual patient data systematic review.

Carnot N Ntafam1, ItunuOluwa Sanusi-Musa2, Robert D Harris3

  • 1Detroit Medical Center Sinai-Grace Hospital, Detroit, MI 48235, USA.

European Journal of Obstetrics & Gynecology and Reproductive Biology: X
|January 25, 2024
PubMed
Summary

Intramural pregnancies (IMPs) are rare ectopic pregnancies lacking established diagnostic protocols. This review synthesizes current knowledge on IMPs, highlighting risk factors, diagnostic imaging, and diverse management strategies to improve clinical outcomes.

Keywords:
HysterectomyHysteroscopyIntramural pregnancyLaparoscopyMagnetic resonance imagingMethotrexateUltrasound

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Area of Science:

  • Reproductive Medicine
  • Gynecologic Surgery
  • Diagnostic Imaging

Background:

  • Intramural pregnancies (IMPs) are a rare subtype of ectopic pregnancy, accounting for approximately 1% of all ectopic pregnancies.
  • Limited awareness and established diagnostic or treatment protocols contribute to challenges in managing IMPs.
  • This condition poses significant risks, necessitating a comprehensive understanding of its characteristics.

Purpose of the Study:

  • To systematically identify and synthesize existing knowledge regarding intramural pregnancies (IMPs).
  • To consolidate information on etiology, pathophysiology, clinical presentations, diagnostic features, and management options for IMPs.
  • To inform the development of diagnostic and treatment guidelines for this rare condition.

Main Methods:

  • Systematic literature review of studies on intramural pregnancies (IMPs) in human subjects.
  • Searches conducted on PubMed and Google Scholar, including articles in English and French.
  • Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and narrative synthesis were employed.

Main Results:

  • Eighty-two cases of IMP were analyzed, with a mean maternal age of 32.07 years and gestational age of 9.27 weeks.
  • Common risk factors included prior curettage (36.58%), salpingectomy (12.19%), assisted reproduction (12.19%), and cesarean delivery (10.97%).
  • Ultrasound was diagnostic in a significant proportion of cases; histopathology confirmed diagnosis. Management varied from conservative to surgical interventions.

Conclusions:

  • Intramural pregnancy (IMP) is a rare but potentially life-threatening condition.
  • A notable percentage of patients are asymptomatic and lack identifiable risk factors, underscoring the importance of diagnostic vigilance.
  • Correlation of clinical history with imaging findings is crucial for prompt diagnosis and improved patient outcomes.