Predictors of uterine rupture in intramural pregnancy and fertility outcomes after different management: For at least 2 years of follow up.

OBJECTIVES

With the widespread use of assisted reproductive technologies, the incidence of intramural pregnancy (IMP) has increased. IMP is a rare ectopic pregnancy in which the gestational sac is entirely embedded within the myometrium. Single-center study on IMP remains scarce. This study aimed to identify risk factors for uterine rupture and to evaluate reproductive outcomes after different treatments.

STUDY

DESIGN

In this retrospective study, 103 women diagnosed with IMP were evaluated. Clinical characteristics, ultrasound features, treatment methods, and reproductive outcomes were analyzed. Chi-square testing and logistic regression were performed to identify factors associated with uterine rupture.

RESULTS

The mean gestational age at diagnosis was 7.4 weeks due to timely ultrasound screening. 84 patients underwent surgery and 19 received conservative treatment. Uterine rupture occurred in 18 patients (21.4%) in the surgical group, and no hysterectomies required. Univariate logistic analysis identified abdominal pain (OR = 13.3), pelvic fluid (OR = 15.2), prior pelvic surgery (OR = 2.1), and larger gestational mass (OR = 1.05) as significant predictors of uterine rupture, whereas vaginal bleeding was associated with a decreased risk (OR = 0.2). In multivariate logistic regression analysis, pelvic fluid and larger gestational mass size were identified as independent factors associated with uterine rupture. During a minimum of two years of follow-up, 32 of 72 patients desiring future fertility achieved a live birth and 28 (87.5%) delivered by cesarean section. Similar reproductive outcomes were observed following conservative and surgical management, though baseline differences between groups limit direct comparisons.

CONCLUSIONS

In IMP, Pelvic fluid and larger gestational mass size were independent predictors of uterine rupture. Both cohorts offer favorable reproductive outcomes when timely diagnosis and individualized management are provided.