INTRAMURAL PREGNANCY WITH NEGATIVE MATERNAL SERUM BETA-HCG - A CASE-REPORT

BACKGROUND: Intramural pregnancy is the rarest form of ectopic pregnan cy. The diagnosis depends upon the sonographic finding of intramural g estational sac-like growth and persistent high beta-human chorionic go nadotropin (beta-hCG) levels after dilatation and curettage. No author s mentioned negative beta-hCG result in such situation. Rarely has the literature contained preoperative sonograms and photographs of postop erative gestational tissue. CASE: A 31-year-old woman presented with v aginal spotting for five months. Six months earlier she underwent dila tation and curettage for blighted ovum at 8 weeks' gestation. Since th en, incidental vaginal spotting was noted. Sonography demonstrated all intramural cyst with fetal pole-like growth. Serum beta-hCG, diagnost ic dilatation and curettage, and hysteroscopic examination were negati ve. Laparotomy for excision of the cyst confirmed an intramural pregna ncy. CONCLUSION: Because of the long period after fetal wastage, negat ive serum beta-hCG was noted in this case. Negative serum beta-hCG was unreliable in the exclusion of intramural pregnancy. With the sonogra phic appearance of intramural gestational sac-like growth, in spite of a negative serum beta-hCG the clinician should be alert to the possib ility of intramural pregnancy.