Data_Sheet_1_Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy.PDF

Background: Intramural ectopic pregnancy is defined as the gestational sac (GS) is entirely within the myometrium, separate from the endometrial cavity and fallopian tubes, which is unsustainable and potentially life-threatening. The data investigating the clinical characteristics, management strategy, and fertility outcomes after treatment of intramural ectopic pregnancies are very limited due to its extreme rarity.
Methods: To investigate the clinical characteristics, treatment options, and fertility outcomes in patients with intramural ectopic pregnancy, a retrospective study included 56 patients was conducted. We also used logistic regression to identify potential risk factors for uterine rupture and hysterectomy in these patients.
Results: The mean age of patients was 31.1 years, with an average gestational age (GA) of 10.0 weeks, and the majority of the patient cohort (83.9%) had uterine or endometrial surgical history. 55.4% of the intramural pregnancy was diagnosed by preoperative imaging examination and 67.7% was detected by ultrasound. There was no dominant predisposed zone of the GS. Common treatment strategies included laparotomy surgery (41.1%) and laparoscopic surgery (35.7%), followed by methotrexate (7.1%) and expectant management (5.4%). Uterine rupture occurred in 9 patients and 8 patients underwent a hysterectomy, but no maternal demise was found. Logistic regression showed that a GA >10 weeks predicted a significantly higher risk of uterine rupture (Odds ratio [OR] 8.000, 95% confidence interval [CI] 1.456–43.966, P = 0.017) and hysterectomy (OR 12.333, 95% CI 2.125–71.565, P = 0.005), and GS located in the fundus also predicted higher probability of uterine rupture (OR 7.000,95% CI 1.271–38.543, P = 0.025). Among the ten patients who had a desire for fertility, 6 of them succeeded and 4 of them successfully delivered with a GA ≥ 34 weeks.
Conclusion: GA > 10 weeks was the risk factor for both uterine rupture and hysterectomy, while patients with GS located in the uterine fundus had a significantly higher risk of uterine rupture. The fertility outcomes were moderate after treatment. The management strategies should be individualized according to disease conditions and the desire for fertility, and early diagnosis is essential for optimizing clinical outcomes.

背景：肌壁间异位妊娠（intramural ectopic pregnancy）指妊娠囊（gestational sac, GS）完全位于子宫肌层内，与宫腔及输卵管相分离，该病症无法维持妊娠且可能危及生命。由于其发病率极低，现有关于肌壁间异位妊娠患者的临床特征、治疗策略及治疗后生育结局的相关研究数据极为有限。
方法：为探讨肌壁间异位妊娠患者的临床特征、治疗方案及生育结局，本研究开展了一项纳入56例患者的回顾性研究。此外，本研究采用logistic回归（logistic regression）分析，以明确此类患者发生子宫破裂及子宫切除术的潜在危险因素。
结果：本研究纳入患者的平均年龄为31.1岁，平均妊娠龄（gestational age, GA）为10.0周；该研究队列中83.9%的患者存在子宫或子宫内膜手术史。55.4%的肌壁间妊娠经术前影像学检查确诊，67.7%经超声检出。未发现妊娠囊存在明确好发部位。常见治疗策略包括剖腹手术（41.1%）与腹腔镜手术（35.7%），其次为甲氨蝶呤（methotrexate）治疗（7.1%）与期待治疗（5.4%）。9例患者发生子宫破裂，8例患者接受了子宫切除术，未出现孕产妇死亡病例。Logistic回归分析显示，妊娠龄＞10周可显著预测子宫破裂风险升高（比值比[Odds ratio, OR] 8.000，95%置信区间[confidence interval, CI] 1.456–43.966，P = 0.017）及子宫切除术风险升高（OR 12.333，95%CI 2.125–71.565，P = 0.005）；妊娠囊位于宫底也可预测子宫破裂概率升高（OR 7.000，95%CI 1.271–38.543，P = 0.025）。在10例有生育需求的患者中，6例成功妊娠，其中4例于妊娠龄≥34周时顺利分娩。
结论：妊娠龄＞10周是子宫破裂与子宫切除术的共同危险因素，而妊娠囊位于宫底的患者子宫破裂风险显著升高。治疗后患者的生育结局处于中等水平。临床治疗策略应根据患者病情及生育需求进行个体化制定，早期诊断对优化临床结局至关重要。