Abdominal pregnancy with a living baby delivered near term

Abstract

T HIS is the first abdominal pregnancy in 17,173 deliveries on the maternity service of the French Hospital in New York. Mrs. R. Z., a white woman, aged 40 years, gravida v, para 0, had her last menstrual period on Dec. 1, 1947, and the estimated date of confinement was Sept. 8, 1948. Her family history was noncontributory. Her personal history included a tonsillectomy at age 15 years, cystitis on two occasions. Her menses began at age 16, but were not regular until age 21 years, when they followed a pattern of 28 to 31 days and lasted three days. When the patient was first seen in May, 1944, ,she gave a history of having had three miscarriages at two to three months (1934, 1942, and 1943). Physical examination revealed a uterus enlarged to the size of about 8 to 10 weeks’ gestation due to a fibromyoma on the right cornu. Her menses were profuse and she had a secondary anemia. This was considered a contributory cause of abortion, but as her basal metabolism was found to be minus 19 per cent, she was placed on thyroid and antianemia therapy. She conceived in November, 1944, but had a spontaneous abortion in January, 1945. A curettage was done for retained secundines, and the fibromyoma on the right cornu was somewhat larger and found to encroach upon the endometrial cavity. Myomectomy was discussed but the patient was reluctant to undergo surgery which would not guarantee a pregnancy. Her metabolism remained low and thyroid therapy was continued. As her menses became more profuse and occurred at intervals of 25 to 26 days, and clots were passed, a laparotomy was done in August, 1946, and a fibromyoma about 7 cm. in diameter was removed from the posterior wall of the uterus, and several smaller subserous fibromas from the anterior wall. When the large intramural fibromyoma was removed, the endometrium was invaded, but the uterus was reconstructed and the patient made an uneventful recovery. Following the operation the patient has monthly episodes of staining for one or two days, but no cramps. The uterus was small in size and a uterine sound was passed to a depth of 6 cm. In 1947 the basal metabolism readings were improved and less thyroid n&s required to keep her in balance. A temperature chart indicated that she was ovulating, but the menses consisted of only a day of spotting. ildoption of a child was discussed and considered. However, in February, 1948, she came to the office with a history of having had her last menses Dec. 1, 1947, and a positive report of an Aschheim-Zondek test done on Jan. 23, 1948. She had some nausea, there were breast changes, and the uterus was enlarged to the size of about 8 we?ks’ gestation with enlargement on the left cornu. Her thyroid medication was continued and she was also given vitamin E, 25 mg. daily. She had a pink show on January 1, and spotted on March 4, but experienced no cramps. On March 12, the uterus was enlarged to the size of 3 months’ gestation and seemed to be regular. Her progress was uneventful until she was about five months pregnant when she was seen at her home on April 26, 1948, because of severe upper right quadrant pa& which was referred to the shoulder. This had followed overindulgence in ice cream, and was attributed to possible gall bladder disease. With elimination of fats from her diet and administration of saline cathartics she recovered promptly.