Angular pregnancy with intrauterine device

Objective

Angular pregnancy is the rare condition in which the gestational sac is implanted in the lateral angle of the uterine cavity. Here, it was aimed to present a case of angular pregnancy occurring in an adult woman and its management.

Case 

A multigravida 26-year-old patient presented to our clinic with complaint of delayed menses. At the vaginal examination of the patient using IUD for 2 years, vagina and cervix were in normal appearances and the string of the IUD was not observed. There was no painful cervical motion at vaginal palpation. A transvaginal ultrasound showed an IUD located in the correct position (Figure 1) and a 5 weeks gestational sac without fetal pole implanted in the left side of the uterine fundus with myometrial thinning was determined when the probe was moved toward the left side. Interstitial line (ultrasonographic finding seen in cornual pregnancy) was not observed. The minimum myometrial thickness around the gestational sac was measured to be 4,3 mm (Figure 2). β-hCG level was 4421 mIU/ml and hemoglobin level was 12,1 g/dl. The diagnosis of angular pregnancy was made with these findings. When the patient was informed about her condition, she said that it was an unintended pregnancy and she wanted to terminate her pregnancy. After receiving the consent of her husband, preoperative preparation was made. IUD was removed first in the operating room and then curettage was performed. No complication occurred. The patient was discharged after postoperative 3rd hour.

Results

Several reports have been published regarding angular pregnancies. Nevertheless, because of a lack of clinical understanding, angular pregnancy seems not to be considered as a clinical entity and most of the cases are presumably not to be diagnosed. Angular pregnancy is a condition in which nidation occurs in just medial portion of the uterotubal junction of uterine cavity and it is not considered as an ectopic pregnancy. In this case, it is worthy of notice not to confuse it with cornual pregnancy. Conservative approach is preferred in angular pregnancy. Pregnancy continues until delivery of a viable fetus in around 60% of the cases.

Conclusion

It may be difficult to diagnose the ectopic pregnancy of unusual location. To make a differentiation between intact intrauterine and extrauterine pregnancy by taking the area of uterine ostium of the fallopian tube into consideration may be sensitive. Differantial diagnosis should be made carefully and treatment strategies should be determined accordingly.

Keywords

Intrauterine Device, Angular Pregnancy, Ectopic Pregnancy

	File/Dsecription
	Figure 1 An IUD located in the correct position in transvaginal ultrasound.
	Figure 2 Angular pregnancy sac located in the left side of the uterine fundus. The minimum myometrial thickness around the gestational sac is 4,3 mm.