Minimally invasive management of intramural pregnancy using ultrasound combined with laparoscopy -based learning experience from a low-middle income country: a case report and review of the literature.

Abstract

Background: Intramural pregnancy is a very rare type of ectopic pregnancy, which is surrounded by uterine myometrium layer and separates from endometrium. To our knowledge, this abnormal location site of ectopic pregnancy remains likely under-recognized and under-reported. Through this paper, we aim to underscore the role of minimally invasive surgery in this uncommon condition where applicable, especially in low-middle income countries.

Case presentation: A 34-year-old Vietnamese female patient (gravida 3 parity 1) was hospitalized due to a diagnosis of intramural pregnancy. Rapidly, the patient underwent laparoscopy for a removal of ectopic pregnancy mass corresponding to 5-6 weeks of gestation, taking into consideration the possibility of conservative surgery. This surgical intervention was carefully performed under ultrasound guidance at operating room. The surgical management resulted in a favorable outcome, though a hysterectomy and laparotomy could be avoided intentionally in this case.

Conclusion: This case report emphasizes the timely detection of intramural pregnancy involving the successful outcome. Moreover, in an early term of intramural pregnancy, uterine conservative management under laparoscopic surgery combined with ultrasound could be a reliable management for this extreme rarity at tertiary center. Further data is required to strengthen this finding.