Intramural ectopic pregnancy: An individual patient data systematic review

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.