Intramyometrial Pregnancy with Uterine Rupture at Second-trimester after Frozen Embryo Transfer

Intramyometrial pregnancy is a rare type of ectopic pregnancy that is difficult to diagnose. We report a case of intramyometrial pregnancy with uterine rupture following frozen embryo transfer (FET), highlighting both the diagnostic challenges and the necessity for prompt surgical management. A 32-year-old woman with diffuse adenomyosis who had undergone in vitro fertilisation followed by FET presented at 14 weeks of pregnancy with acute abdominal pain and signs of hemoperitoneum. Imaging showed intra-abdominal bleeding and absent foetal cardiac activity. Laparoscopy revealed a rupture in the posterior uterine wall, with the placenta deeply embedded within the myometrium. Conservative surgical repair was successfully performed without necessitating a hysterectomy, and the patient fully recovered postoperatively. Although intramural pregnancy is rare, it is a potentially fatal form of ectopic pregnancy that can result in uterine rupture if left undiagnosed. Clinicians should maintain a high level of suspicion for early pregnancies achieved through assisted reproductive technologies, especially in patients with prior uterine procedures. Prompt recognition and timely surgical intervention can be lifesaving and preserve reproductive potential.