Abdominal pregnancy followed by elimination of the placenta through the bladder: Case report

Abstract

A 36-year-old gravida vi, para v (No. 89527), whose last menstrual period was on Dec. 24, 1954, was admitted to Hahnemann Hospital Obstetrical Service after 35 weeks of amenorrhea, complaining of nausea, vomiting, severe abdominal pain, and obstipation of 7 days’ duration, and leg cramps for 48 hours. The patient had had an appendectomy at age 33. After 3% months’ amenorrhea she had been admitted to an out-of-state hospital because of severe right lower quadrant abdominal pain and pain in the right shoulder, and an eetopic pregnancy was considered. The pain, however, subsided, and she was discharged after 9 days. On admission to Hahnemann Hospital, the patient was found to be hypotensive, pyretic, anuric, and in an advanced state of dehydration. The abdomen was distended, tympanitic, and diffusely tender. Auscultation failed to reveal evidence of peristalsis. A fetus of fair size could be palpated in a transverse lie. Fetal movements were distinct and the fetal heart rate was regular at 156 per minute. A few cubic centimeters of almost black urine were obtained by catheterization of the bladder. Vaginal examination disclosed the cervix to be hypertrophied and extremely soft. The external OS and canal admitted a finger; the internal OS was patulous. No membranes or fetal parts were palpated. The uterine body was difficult to outline but was felt ti1 lie to the right of the midline and to be the size of a 12 to 14 weeks’ gestation. The provisional diagnosis was (1) secondary abdominal pregnancy at 35 weeks’ gestation, living baby; (2) bowel obstruction, probably high ileal or low jejunal, secondary to the abdominal pregnancy or the old appendectomy; (3) lower nephron nephrosis; (4) marked dehydration, electrolyte and protein imbalance. The flat plate of the abdomen was thought to show an intrauterine pregnancy, transverse lie, placenta located on the left uterine wall, and small bowel obstruction. The patient improved rapidly under conservative therapy ant1 5 days after admission was operated upon. When the abdomen had been opened, loops of distended small intestine were encountered. The intestine was in good condition, however. The easily recognizable amniotic sac was opened and a living, 4 pound, 8 ounce male child in good condition was delivered. The baby is still living, and to date no congenital abnormalities have been demonstrated. The umbilical cord was doubly ligated with cord tape close to the placenta..