Hysteroscopy in the treatment of intramural ectopic pregnancy: a case report

Intramural ectopic pregnancy (IMP) refers to the implantation of a fertilized egg in the myometrium. In this case a 42-year-old female patient was diagnosed with a space-occupying lesion in the uterus during an examination performed more than 3 months after a medical abortion. The level of beta-human chorionic gonadotropin (beta-HCG) increased gradually three months after the abortion but decreased two months after the intramuscular injection of methotrexate (MTX). Hysteroscopy was performed and revealed IMP with an abnormal HCG level. The HCG level was reduced to negative after resection. IMP should be considered for patients with a gestational sac or mass in the myometrium and unsatisfactory beta-HCG reduction or pelvic hematocele and hemoperitoneum. Hysteroscopic examination and treatment can be performed when the beta-HCG level drops below 2,000 mIU/ml.