Sefa ARLIER, Sibel ÖNCEL YAVUZ
Anatolian Journal of Obstetrics and Gynecology Research - 2025;2(3):135-137
Intramyometrial ectopic pregnancy (IMP) is an exceptionally rare form of ectopic gestation, representing <1% of cases. It poses diagnostic challenges as it often mimics leiomyoma or interstitial pregnancy on imaging. A 42-year-old woman with a history of adenomyosis and previous salpingectomy was admitted with acute abdomen and hypovolemic shock. Preoperative laboratory tests revealed hemoglobin (Hb): 9.2 g/dL, hematocrit: 28%, white blood cell: 12,300/mm³, platelet: 210,000/mm³, and beta-human chorionic gonadotropin: 65,000 mIU/mL. After emergency laparotomy for ruptured intramyometrial pregnancy , the postoperative Hb level was 7.4 g/dL; however, this value may have been relatively overestimated due to preoperative hemoconcentration. Transvaginal ultrasonography revealed a gestational sac embedded in the uterine fundal myometrium with fetal cardiac activity . Emergency laparotomy revealed a ruptured intramyometrial gestation with massive hemoperitoneum. Estimated intraoperative blood loss was 1800 mL, requiring transfusion of three units of red blood cells and two units of fresh frozen plasma. Total abdominal hysterectomy and salpingectomy were performed. Histopathological analysis confirmed intramyometrial pregnancy associated with adenomyosis. This case highlights the importance of considering IMP in the differential diagnosis of abnormal uterine masses, especially in patients with prior uterine surgery or adenomyosis. Early recognition and prompt surgical intervention are important to prevent catastrophic and potentially life-threatening hemorrhage.
