Case Of Advanced Abdominal Pregnancy Research Articles

Prenatal Diagnosis and Management of Advanced Abdominal Pregnancy in Dr. Moewardi Hospital Surakarta: A Case Series

Background: The abdominal pregnancy is a pregnancy anywhere in the abdominal cavity other than the tube, ovary, and broad ligament. Abdominal pregnancy has 7.7 times greater risk than tubal pregnancy and 90 times greater than intrauterine pregnancy. This study aims to reveal the diagnosis and treatment of abdominal pregnancy in Dr. Moewardi Hospital Surakarta. Subjects and Method: This was a case series study conducted at Dr. Moewardi Hospital Surakarta. This study report three cases of advanced abdominal pregnancy at Dr Moewardi Hospital (2019 – 2020), that consisted of two cases of advanced abdominal pregnancy to term, and one advanced abdominal pregnancy with acute abdomen. Case presentation : Case 1 (it was found abdominal pregnancy at 30 weeks), the condition of the mother and the fetus was good, the pregnancy was continued until the gestational age was term. The patient was given corticosteroids for lung maturation and magnesium sulfate for neuro­protection. Case 2 (an abdominal pregnancy was found at term), it was decided to immediately terminate it with good preoperative preparation. Both patients in case 1 and case 2 had good result in both the mother and the fetus. The placenta was left in situ in both cases to prevent massive bleeding and injury to the gastrointestinal organs. Case 3 (advanced abdominal pregnancy with acute abdominal symptoms) decided to undergo an emergency laparotomy and removal of the placenta. Conclusion: Abdominal pregnancy must be diagnosed and managed properly to reduce maternal mortality and morbidity. In advanced abdominal pregnancy, it could be considered to continue the pregnancy until the term. The placenta management of in situ without methotrexate might be considered in cases of abdominal pregnancy. Keywords: abdominal pregnancy, prenatal diagnosis, treatment Correspondence: Uchti Akbar. Departement of Obstetrics & Gynaecology, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital, Surakarta, Jl. Kolonel Sutarto, Surakarta 57126, Central Java. Email : druchtiakbar@gmail.com. Mobile: 081397167176. Journal of Maternal and Child Health (2021), 06(04): 516-522 https://doi.org/10.26911/thejmch.2021.06.05.01

Anaesthetic Management of a Patient with Advanced Abdominal Pregnancy, Intrauterine Foetal Death and Celiac Disease

Abdominal pregnancy is a rare form of ectopic pregnancy where implantation of fertilised ovum occurs in the abdominal cavity. If diagnosed late maternal and foetal mortality is very high. The major cause of death in abdominal pregnancy is haemorrhage. The case report is about a 31-year-old gravida two with 36 weeks of gestation period with Intrauterine Foetal Death (IUFD) and celiac disease. Celiac disease is a chronic malabsorptive disease of the small intestine occurring due to hypersensitivity to gluten ingestion. Due to chronic malabsorption, the patient presented with calcium deficiency. She also had lesions of dermatitis herpetiformis over the whole body sparing only the face. It is a rare case of advanced abdominal pregnancy with the IUFD, with celiac disease. The patient was managed successfully under general anaesthesia with preparedness for difficult airway management, securing wide bore peripheral cannulas, central venous cannulation and invasive blood pressure monitoring. Massive haemorrhage intraoperatively was managed with crystalloids, colloids, blood products and tranexamic acid. The intraoperative period was uneventful. The patient was extubated at the end of the surgery, and followed-up in a high dependency unit.

Advanced abdominal pregnancy: a search for consensus. Review of literature along with case report

Advanced abdominal pregnancy is a highly morbid form of extrauterine gestation that demands skilled management. Despite advancement in antenatal care and imaging modalities, undiagnosed cases of advanced abdominal pregnancies are still reported. We report a case of asymptomatic abdominal pregnancy with healthy fetus advanced till 40 + 4weeks period of gestation. Her diagnosis was not established even after obstetrical evaluation and cesarean section at primary care hospital. To the best of our knowledge, less than 10 postdated cases of abdominal pregnancy have been reported so far in the literature. This case emphasizes the need to re-awaken awareness and high index of suspicion to diagnose such cases. Details of all the cases pertaining to advanced abdominal pregnancies reported after 2013 were reviewed and summarized. We searched electronic medical database in English using keywords related to abdominal pregnancy. Bibliographies of the relevant articles of advanced abdominal pregnancy published from 2013 onwards were reviewed and then cross searched to identify further relevant studies. A total of 26 cases of advanced abdominal pregnancy including index one were reviewed. All preoperatively diagnosed cases of abdominal pregnancy at earlier gestation were given conservative management and resulted in live births. The incidence of malformations in live births was 24%. We are of considered opinion that conservative strategy is a feasible option in selected cases of advanced abdominal pregnancy yet there is a need of standardization of treatment principles for such cases to optimize fetomaternal outcome.

Advanced abdominal pregnancy in HIV- infected women: A case series

We report 3 cases of advanced abdominal pregnancy in HIV-positive women managed at the East London Hospital complex between 2005 and 2009. Despite the complexity of diagnosis and management of this life-threatening condition, no adverse effects occurred in the women in our series and 2 of the babies survived.

Ultrasonographic follow-up of involuting placenta in advanced abdominal pregnancy diagnosed by magnetic resonance imaging

We successfully treated a case of advanced abdominal pregnancy which was diagnosed with ultrasonography and magnetic resonance imaging in a woman of 20th week of pregnancy who did not receive any prenatal care. It is advisable to leave the placenta in situ because removing the placenta may be associated with severe hemorrhage. Furthermore, identifi cation of uterine wall around the fetus and the placenta is very important in diagnosing abdominal pregnancy.

Advanced abdominal pregnancy: case report and review of 163 cases reported since 1946

Though relatively rare, advanced abdominal pregnancy (AAP) can have dramatic and catastrophic consequences for the foetus and the mother. Difficult to diagnose pre-operatively, AAP presents special challenges to the physician working in remote areas with limited resources for diagnosis and management. A case of AAP received in our hospital in Kolofata, Cameroon, is presented and followed by a review of 163 other cases reported from 13 countries since 1946. A physician working in a remote district with an active maternity service should expect to encounter several cases of AAP during his or her working lifetime. Pre-operative diagnosis of AAP allows time for thoughtful preparation of the patient, family and medical team; however, to be diagnosed, AAP must first be considered. Diagnosis requires a high index of suspicion, and this should be triggered by any of a number of symptoms and signs reported in many cases of AAP. An unusual echographic appearance of the placenta was present in our case and prompted a more thorough investigation that confirmed the diagnosis. This finding has been reported by others and should be added to the list of signs and symptoms that might lead to a diagnosis of AAP in time to save the surgeon from an unpleasant and dangerous surprise.

Abdominal pregnancy: ultrasound diagnosis aided by the balloon of a Foley catheter

Abdominal pregnancy: ultrasound diagnosis aided by the balloon of a Foley catheter

Surgical packing as a means of controlling massive haemorrhage in association with advanced abdominal pregnancy

A case of advanced abdominal pregnancy was diagnosed at laparotomy. During surgery, there was massive haemorrhage from the placenta which was controlled using surgical gauze packing.

Advanced Abdominal Pregnancy: A Study of 13 Consecutive Cases Seen in 1993 and 1994 at Komfo Anokye Teaching Hospital, Kumasi, Ghana

Thirteen cases of advanced abdominal pregnancy (AAP) managed at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, over a two-year period (1993-1994) are presented. An incidence ratio of one advanced abdominal pregnancy to 1,320 deliveries occurred during this period. The ratio of advanced abdominal pregnancy to ectopic pregnancy was 1:43.7. The perinatal mortality rate and maternal case fatality rates were 69.6% and 15.3% respectively. Recurrent abdominal pains in the gravid patient with abnormal fetal lie and prior history of tubal pregnancy and/or previous abdominal surgery were significant findings in the cases reviewed. These findings should, therefore, always prompt lucid and elaborate ultrasound examination of a pregnancy to exclude abdominal pregnancy.

Advanced abdominal pregnancy: a study of 13 consecutive cases seen in 1993 and 1994 at Komfo Anokye Teaching Hospital, Kumasi, Ghana.

Thirteen cases of advanced abdominal pregnancy (AAP) managed at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, over a two-year period (1993-1994) are presented. An incidence ratio of one advanced abdominal pregnancy to 1,320 deliveries occurred during this period. The ratio of advanced abdominal pregnancy to ectopic pregnancy was 1:43.7. The perinatal mortality rate and maternal case fatality rates were 69.6% and 15.3% respectively. Recurrent abdominal pains in the gravid patient with abnormal fetal lie and prior history of tubal pregnancy and/or previous abdominal surgery were significant findings in the cases reviewed. These findings should, therefore, always prompt lucid and elaborate ultrasound examination of a pregnancy to exclude abdominal pregnancy.

Advanced abdominal pregnancy in the developing countries

SummaryTwelve cases of advanced abdominal pregnancy: managed at Khartoum teaching hospital, Khartoum University. Sudan, over a period of five years were reviewed. An incidence of 1/5000 deliveries occurred in this series. There was no maternal death but the perinatal mortality rate was 75 per cent. Of the three liveborn infants: two had pressure deformities, all of the three were mall for gestational age. The other nine cases were true lithopedion which were the end result of undiagnosed and untreated advanced abdominal pregnancy.

Advanced abdominal pregnancy--a review of 23 cases.

Twenty-three cases of advanced abdominal pregnancy were managed at Harare Hospital, Zimbabwe, over a 10 year period. The incidence was 1 in 9500 total deliveries and 1 in 60 ectopic pregnancies. There were no maternal deaths but perinatal mortality was 83%. Of the 5 liveborn infants, 4 had pressure deformities and 3 were small for gestational age. There was one neonatal death due to pulmonary hypoplasia. Diagnosis is difficult and is often first suggested by failed induction of labour in a case of presumed intrauterine death. Abnormal presentation of the fetus, displacement of the cervix and anaemia were the most common clinical features. At operation, haemorrhagic shock occurred more frequently when attempts were made to remove the placenta. However, the average post-operative stay of patients who had placental tissue left was 22.4 days compared with 8.3 days for those who had the placenta removed. It is recommended that the placenta be removed only if its entire blood supply can be ligated. Partial removal of the placenta is the most hazardous procedure and should not be undertaken.

Abdominal Pregnancy

Nine cases of early and six cases of advanced abdominal pregnancy managed at the University of Mississippi Medical Center over a 20-year period are reviewed. An incidence of one abdominal pregnancy in 4857 deliveries occurred in this series. A perinatal mortality rate of 83% and no maternal mortality were noted, in contrast to published rates of 40-95% and 0.5-18%, respectively. Important current concepts of management include difficulty in diagnosis, predisposing risk factors, suggestive signs and symptoms, the diagnostic role of ultrasound, and the appropriate surgical management of parturients with this ominous pregnancy complication.

FETAL LUNG GROWTH IN EXTRA-UTERINE PREGNANCY

Several hundred cases of advanced abdominal pregnancy have been reported. Although 20-40% resulted in livebirths, only 50-70% of those survived the early neonatal period. The major cause of death is unknown and most infants have multiple deformities involving mainly the joints and skin. Using an animal model, we freed rat fetuses from the uterus without disturbing the placental implantation site. The fetuses were allowed to reside in the peritoneal cavity, either within intact membranes (with amniotic fluid), or outside of the fetal membranes. Untouched littermate fetuses served as controls. The surgery was performed on either days 17, 18 or 19 of gestation and the outcome was analyzed at term (i.e. 2,3, or 4 days later). The fetuses were then killed, photographed and body, lung, liver, brain and placenta weights recorded. Total lung DNA was determined. Results: Extra-uterine fetuses with intact membranes were in all respects indistinguishable from littermate controls. Extra-uterine and extramembranous fetuses weighed slightly less than controls, all had thin, shiny skin with webs and contractures of multiple joints. After correction for body weight, only their lungs weighed significantly less (p<.01) and contained less DNA (p<.02). Lung DNA per gram of fetal weight was less (p<.05). The difference was even more significant following surgery on days 17 and 18. This animal model highlights the protective role of the amniotic environment and suggests that lung hypoplasia is a major cause of neonatal death in human abdominal pregnancy.

Case of advanced abdominal pregnancy.

Case of advanced abdominal pregnancy.

A Case of Advanced Abdominal Pregnancy

A Case of Advanced Abdominal Pregnancy