Abdominal Preqnancy

Abstract

With the advent of pneumoperitoneum, hysterography, amniography, and uterine soft-tissue studies, certain information of considerable value has been made available to the obstetrician. Pregnancy with its many complications can often be diagnosed early by means of roentgen examination, and the use of this method in the determination of abdominal pregnancy has become an important phase of obstetrics. This fact is of particular interest since abdominal pregnancy is considered to be an uncommon condition, and its diagnosis is often difficult when physical examination and clinical evidence alone are employed. Hellman and Simon, in 1935, collected 311 cases of abdominal pregnancy from the literature. We are able to find 42 additional cases reported during the last six years. Of this number, only 16 had been examined roentgenologically, a correct diagnosis being made in 7 instances, or 43 per cent. Bermann, in 1925, is credited with being the first to use hysterography in the diagnosis of abdominal pregnancy. Since then Sarkar, Greenhill, Friedman, Polowe, Harris, and others have reported cases diagnosed by this method. While hysterography has given valuable information in the diagnosis of abdominal pregnancy (Fig. 1), it has been accompanied occasionally by certain undesirable complications, and for this reason means have been sought to replace the method, at least in part, with a safer one. This has led to uterine soft-tissue studies, the importance and technic of which have been explained by Snow and Powell, and Brown and Dippel. At Charity Hospital, in New Orleans, there have been about 25,000 deliveries during the past five years, of which 10 (0.04 per cent) were proved cases of abdominal pregnancy. Of the 10 patients, only 7 were examined by roentgen rays, and in 2 of these only flat films of the abdomen were made; the remaining 5 were examined by soft-tissue studies and hysterograms. In only one case (No. 6 in the table) was a soft-tissue study alone made. A preoperative diagnosis, confirmed by operation, was made in all 5 cases; obviously the flat films made in the other 2 cases of this series (Nos. 1 and 4) were of no help in diagnosis. In the 4 cases in which both methods were used (Nos. 3, 7, 9, and 10), a hysterogram was made only after we were reasonably sure, by a diagnostic criterion to be described later in this article, that the fetus was extra-uterine. There were no abortions following the injection of the opaque media into the gravid uterus, though the method has produced abortion in many reported cases. In spite of the value of hysterography in the diagnosis of abdominal pregnancy, its use is limited by this danger. Also, it can be used only in certain cases. For these reasons we hope that, with soft-tissue studies alone and certain diagnostic criteria, we will only occasionally require this method in our examinations.