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Background <p>Intramural pregnancy (IMP) is a subtype of ectopic pregnancy that can lead to life-threatening uterine rupture and severe hemorrhage. However, the clinical manifestations of IMP are nonspecific, making early clinical recognition challenging. This study reports a case in which two fresh embryos were transferred in the same cycle, and subsequent intramural pregnancies occurred twice. This study provides comprehensive clinical data for clinicians to gain a deeper understanding of this condition.</p> Case presentation <p>A 37-year-old woman underwent the transfer of two fresh embryos in a single cycle. Five days after transplantation, she developed abdominal pain. Ultrasonography revealed a mixed-echo mass adjacent to the right adnexal region along with significant intra-abdominal fluid. Diagnostic laparoscopy revealed a ruptured purplish-blue nodular mass within the myometrium with active bleeding. Chorionic villi were identified within the mass, and laparoscopic surgical removal of the intramural gestational lesion was performed. Postoperatively, the human chorionic gonadotropin (HCG) level decreased suboptimally. Further ultrasound and magnetic resonance imaging (MRI) studies revealed an abnormal signal near the right uterine cornua. Consequently, persistent ectopic pregnancy or newly developed ectopic gestation in the right adnexal region was suspected. Hysteroscopic and laparoscopic examinations were subsequently performed, revealing a gestational sac embedded within the muscular layer of the right uterine cornua (distinct from the previous implantation site), with no connection to the uterine cavity or fallopian tubes. A repeat diagnosis of IMP was established, and laparoscopic excision of the lesion was performed.</p> Conclusion <p>Clinical cases of IMP are relatively rare, without timely detection and treatment, uterine rupture can easily occur, leading to the loss of fertility and even life-threatening outcomes. Therefore, early and accurate diagnosis and treatment are key to the prevention and treatment of complications. This case report can serve as an education resource for gynecologists, reproductive medicine specialists, and radiologists, helping to expand their clinical knowledge and to improve the accuracy of the medical services they provide to patients.</p>

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Sequential intramural pregnancies in the right uterine cornu after the transfer of two embryos in a single cycle: a case report and literature review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月19日

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  • Litong Yin,
  • Zhaolin Gong,
  • Xinyu Xiao,
  • Xin Li,
  • Xia Yu,
  • Ling Cui,
  • Yonghong Lin,
  • Fang Wang,
  • Li He

摘要

Background

Intramural pregnancy (IMP) is a subtype of ectopic pregnancy that can lead to life-threatening uterine rupture and severe hemorrhage. However, the clinical manifestations of IMP are nonspecific, making early clinical recognition challenging. This study reports a case in which two fresh embryos were transferred in the same cycle, and subsequent intramural pregnancies occurred twice. This study provides comprehensive clinical data for clinicians to gain a deeper understanding of this condition.

Case presentation

A 37-year-old woman underwent the transfer of two fresh embryos in a single cycle. Five days after transplantation, she developed abdominal pain. Ultrasonography revealed a mixed-echo mass adjacent to the right adnexal region along with significant intra-abdominal fluid. Diagnostic laparoscopy revealed a ruptured purplish-blue nodular mass within the myometrium with active bleeding. Chorionic villi were identified within the mass, and laparoscopic surgical removal of the intramural gestational lesion was performed. Postoperatively, the human chorionic gonadotropin (HCG) level decreased suboptimally. Further ultrasound and magnetic resonance imaging (MRI) studies revealed an abnormal signal near the right uterine cornua. Consequently, persistent ectopic pregnancy or newly developed ectopic gestation in the right adnexal region was suspected. Hysteroscopic and laparoscopic examinations were subsequently performed, revealing a gestational sac embedded within the muscular layer of the right uterine cornua (distinct from the previous implantation site), with no connection to the uterine cavity or fallopian tubes. A repeat diagnosis of IMP was established, and laparoscopic excision of the lesion was performed.

Conclusion

Clinical cases of IMP are relatively rare, without timely detection and treatment, uterine rupture can easily occur, leading to the loss of fertility and even life-threatening outcomes. Therefore, early and accurate diagnosis and treatment are key to the prevention and treatment of complications. This case report can serve as an education resource for gynecologists, reproductive medicine specialists, and radiologists, helping to expand their clinical knowledge and to improve the accuracy of the medical services they provide to patients.