30 years female so + iui pregnancy serum βhcg – 520 miu/ml evs – 6 wks gs in anterior...
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CASE PRESENTATION
DR.MINI GOPALKANYAKUMARI IVFDR.GOPALA PILLAIS
HOSPITALNAGERCOIL
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30 Years Female
SO + IUI Pregnancy
Serum βHCG – 520 mIU/ml
EVS – 6 wks GS in Anterior Myometrium in LUS
YS+ ,FP+, Fh+
Endometrial cavity empty
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Past H / -
Primary Infertility of 3 yrs
M/H – Irregular CyclesHysterolaparoscopy
Single CavityRt osteum obscuredLt osteum clearUterus bulky adenomyoticSeedling myoma anterior left
cauterisedRt adnexa absentLt ovarian & POD adhesions
releasedLt tube patent
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Treatment
Conservative – S: β HCG - <1000 mIU/ml
Unruptured, stable patient
EVUSGA and Mtx injection
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EVUSGA
16/07 26/07 29/07 30/07 01/08 08/08 16/8 24/8 30/8
Follow up
β HCG Regression Curve
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Intra Myometrial Pregnancy
Rarest ectopic pregnancy
Difficult diagnosis
GS within uterine wall
Separate from uterine cavity & F : tube
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Causes
Previous uterine trauma
Recurrent curettage
Previous caesarean section
Myomectomy
Adenomyosis
UAE for fibroids
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Symptoms & signs
+ ve pregnancy test
Abdominal pain
Irregular bleeding PV
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DIAGNOSIS
ENDO VAGINAL USG
MRI
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Differential Diagnosis
Pregnancy in uterine diverticulum
Degenerating Myoma
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Complications
Uterine rupture
Placenta accreta
External migration
Maternal mortality – 2.5 %
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Treatment
Conservative – Local MT x
Systemic MT x Surgical - Enucleation
Laparoscopic
Laparotomy
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Conclusion
Early Diagnosis
Fertility Sparing
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