June 30th, 2022

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Intramural Pregnancy with Negative Maternal Serum b-hCG: A Case Report
Authors:  Yao-Yuan Hsieh, M.D., Chi-Chen Chang, M.D., Horng-Der Tsai, M.D., Lian-Shun Yeh, M.D., Tai-Yen Hsu, M.D., and Tung-Chuan Yang, M.D.
BACKGROUND: Intramural pregnancy is the rarest form of ectopic pregnancy. The diagnosis depends upon the sonographic finding of intramural gestational sac- like growth and persistent high b-human chorionic gonadotropin (b-hCG) levels after dilatation and curettage. No authors mentioned negative b-hCG result in such situation. Rarely has the literature contained preoperative sonograms and photographs of postoperative gestational tissue.

CASE: A 31-year-old woman presented with vaginal spotting for five months. Six months earlier she underwent dilatation and curettage for blighted ovum at 8 weeks# gestation. Since then, incidental vaginal spotting was noted. Sonography demonstrated an intramural cyst with fetal pole-like growth. Serum b-hCG, diagnostic dilatation and curettage, and hysteroscopic examination were negative. Laparotomy for excision of the cyst confirmed an intramural pregnancy.

CONCLUSION: Because of the long period after fetal wastage, negative serum b-hCG was noted in this case. Negative serum b-hCG was unreliable in the exclusion of intramural pregnancy. With the sonographic appearance of intramural gestational sac-like growth, in spite of a negative serum b-hCG the clinician should be alert to the possibility of intramural pregnancy. (J Reprod Med 1998;43:468-470)
Keywords:  pregnancy, ectopic; chorionic gonadotropin, beta subunit, human; intramural pregnancy
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