Korean J Obstet Gynecol.  2012 Mar;55(3):213-217. 10.5468/KJOG.2012.55.3.213.

Primary uterine serosal pregnancy with myometrial invasion

• Kang MJ
• Joo JK
• Kang JH
• Joo IS
• Park Y
• Seo KY

• KMID: 2274131
• DOI: http://doi.org/10.5468/KJOG.2012.55.3.213

Abstract

Ectopic pregnancy is reported to be 1.5%-2% of all pregnancies. Ectopic pregnancy varies with the site of implantation; abdominal pregnancy has been reported to occur in approximately 1% of patients with ectopic pregnancy. Especially, uterine serosal pregnancy is an extremely rare form of abdominal pregnancy. Although variable diagnostic imaging methods have been developed, accurate diagnosis of the abdominal pregnancy using noninvasive imaging study is still difficult. Delayed diagnosis leads to high maternal morbidity and mortality in relation to massive bleeding. Therefore, diagnostic laparoscopy or laparotomy is generally considered to patients with uncertain diagnosis of the abdominal pregnancy. We experienced a case of primary uterine serosal pregnancy that had a rupture of gestational sac with myometrial invasion. We finally confirmed a definite site of the ectopic pregnancy through laparoscopic exploration. That precise location could be not found by pelvic ultrasonography and magnetic resonance imaging. The patient underwent a subtotal hysterectomy.

Keyword

Ectopic pregnancy; Abdominal pregnancy; Uterine serosal pregnancy; Diagnostic laparoscopy

MeSH Terms

Delayed Diagnosis
Diagnostic Imaging
Female
Gestational Sac
Hemorrhage
Humans
Hysterectomy
Laparoscopy
Laparotomy
Magnetic Resonance Imaging
Pregnancy
Pregnancy, Abdominal
Pregnancy, Ectopic
Rupture

Figure

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  Fig. 1 Pelvic magnetic resonance imaging. A cavity (arrow) that showed high signal intensity on T2-weighted image was seemed as a gestational sac in the region of left ovary.

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  Fig. 2 Laparoscopic finding. There was about 2.5 cm sized bulging mass (arrow) in the left posterolateral serosa of the uterus.

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  Fig. 3 There was an irregular denuded implantation site at left anterolateral surface of the subtotally resected uterus. The rupture of gestational sac and massive hemorrhage occurred in this uterine surface.

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  Fig. 4 (A) Microscopic examination of the uterus showed intermediate trophoblasts (arrow) and stria of Nitabuch on the serosal surface indicating implantation site. Uterine serosa (arrow head) (H&E, ×40). (B) Chorionic villi and trophoblasts were attached to the left anterolateral uterine surface. The trophoblasts invading into myometrium were also noted (H&E, ×40). (C) Endometriosis with the decidual reaction was focally noted around the implantation site (H&E, ×100).

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