Intramural ectopic pregnancy implanting in adenomyosis

Ginsburg, Kenneth A.; Quereshi, Faisal; Thomas, Michael; Snowman, Brenda

doi:10.1016/s0015-0282(16)60506-x

Cited by 56 publications

(46 citation statements)

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“…Three possibilities have been described in a secondary abdominal pregnancy: (a) the fetus escapes into the abdominal cavity following a uterine rupture, but placental attachments are retained (Lederer & Fisher 1960), (b) the fetus develops further with a gradual and eventual complete reimplantation of the placenta in the abdominal cavity (Bunte & Hildebrandt 1975) or (c) an internal abortion may occur in which the conceptus escapes into the abdominal cavity, along with a loss of placental attachment (Madani & Tirgari 1984). Other less frequent ectopic locations are the cornual, ovarian and cervical kind, where an extrauterine pregnancy may develop (Ginsburg et al 1989, Bouyer et al 2002, Kraiem et al 2004, Tarim et al 2004.…”

Section: Ectopic Pregnancy Typesmentioning

confidence: 99%

Ectopic pregnancy in animals and humans

Corpa¹

2006

Reproduction

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Ectopic pregnancy denotes a pregnancy occurring elsewhere than in the cavity of the uterus. This pathology has been recognised for years and it causes numerous maternal deaths during the first trimester of pregnancy. While this condition is wellknown in humans, it is rarely diagnosed in animals. However, the causes and mechanisms leading to an ectopic implantation of the ovum are not always clearly defined in humans or animals. Two types of ectopic pregnancy are mainly recognized: (1) tubal pregnancy occurs when an oocyte is fertilized and then remains in the oviduct and (2) abdominal pregnancy occurs when the gestation develops in the peritoneal cavity. The latter may be subdivided into two subtypes: the primary form, when a fertilized oocyte enters the peritoneal cavity and becomes attached to the mesentery or abdominal viscera, and the secondary form, which follows the rupture of an oviduct or the uterus after the fetus has been implanted, and the fetus is expelled into the peritoneal cavity. Cornual, ovarian and cervical ectopic locations are less frequent. Several differences exist in ectopic pregnancies between human beings and animal species. While abdominal pregnancy has been described in both human and animal species, tubal ectopic pregnancies would appear to be restricted to primates. Other than anecdotal cases, this pathological condition does not occur in laboratory, domestic or farm animals. Several factors are described as being the cause of these differences.

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Section: Ectopic Pregnancy Typesmentioning

confidence: 99%

Ectopic pregnancy in animals and humans

Corpa¹

2006

Reproduction

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“…The exact mechanism of the hemorrhage is unclear because adenomyosis involves only the basal layer of the endometrium, not the functional layer. Nevertheless, hormonal receptors exhibiting some degree of proliferative and secretory changes during the menstrual cycle have been identified in adenomyotic implants (7,8). However, whether the hemorrhage within implants of adenomyosis represents a sequela of hormonal changes during the menstrual cycle or is the result of spontaneous hemorrhage has not yet been elucidated.…”

Section: Pelvic Imaging Volume 19 Special Issuementioning

confidence: 99%

Uterine Adenomyosis: Endovaginal US and MR Imaging Features with Histopathologic Correlation

Reinhold¹,

Tafazoli²,

Mehio³

et al. 1999

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Uterine adenomyosis is a common gynecologic condition that is characterized by the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. The histopathologic features of adenomyosis are varied and contribute to its imaging appearance. The accompanying smooth muscle hyperplasia produces the typical gross appearance of adenomyosis and corresponds to areas of decreased echogenicity at endovaginal ultrasonography (US) and areas of decreased signal intensity at magnetic resonance (MR) imaging. Endovaginal US also shows heterogeneity of the myometrial echotexture, which corresponds to small echogenic islands of heterotopic endometrial tissue surrounded by the hypoechoic smooth muscle. On T2-weighted MR images, bright foci are seen in areas of abnormal low signal intensity within the myometrium in approximately 50% of patients. These foci correspond to islands of heterotopic endometrial tissue, cystic dilatation of heterotopic glands, or hemorrhagic foci. With the advent of high-resolution imaging techniques, signs associated with the presence of heterotopic endometrial tissue are being detected with increasing frequency. These signs include myometrial cysts, myometrial nodules, linear striations, pseudowidening of the endometrium, and poor definition of the endomyometrial junction. Pitfalls in diagnosis of uterine adenomyosis include leiomyoma, endometrial carcinoma, myometrial contractions, and muscular hypertrophy.

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“…1 This type of pregnancy is extremely rare. 2,3 It constitutes less than 1% of the total number of ectopic pregnancies 1,2 and was first reported by Doederlein et al in 1913.…”

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confidence: 99%

“…2,3 It constitutes less than 1% of the total number of ectopic pregnancies 1,2 and was first reported by Doederlein et al in 1913. 4 The etiology of intramural pregnancy is unclear and may result from increased lytic activity of the syncitiotrophoblast and defective decidualization, which allows the conceptus to penetrate the myometrium, or implant in the serosa following external migration 4,5 ; from previous uterine trauma, resulting in a sinus tract within the endometrium (eg, previous dilatation and curettage, caesarean section, or myomectomy 6 ); from implantation on a focus of intramural adenomyosis (microscopic sinus tracts associated with adenomyosis) 1,3 or from a difficult embryo transfer following in vitro fertilization, resulting in the creation of false passage. 5,7 Intramural pregnancy can be complicated by rupture and hemorrhage; thus, early diagnosis is important.…”

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confidence: 99%