P35.06: Intramural Pregnancy with a past history of artificial abortion ‐ A case report

Intramural ectopic pregnancy is very rare and the incidence is less than 1% of ectopic pregnancy. We present a case report of a 37-year-old woman with a complication of adenomyosis and a past history of an artificial abortion. She came to our hospital with a symptom of lower abdominal pain and a small amount of vaginal bleeding. Transvaginal Ultrasound revealed 3.3 cm of gestational sac in the uterus which had no growth for the last 9 days. Although we performed dialatation and currettage, we couldn't reach gestational sac. Pathologic examination revealed pregnant changes of the endometrium, but no fetal elements were found with serum hCG level of 21 392 mIU/mL. With magnetic resonance imaging and transvaginal ultrasound, we identified the gestational sac in the anterior uterine wall, which located 5 mm below the surface of uterus behind the bladder. At laparotomy, a 3 cm mass in diameter was found intramurally and resected successfully. Serum hCG level dropped down to 237.6 mIU/mL after a week. Pathologic examination revealed chorionic villi. This patient was discharged from the hospital a week after the operation with no complications. Intramural pregnancy was diagnosed and treated successfully.