Diagnosis Of Abdominal Pregnancy Research Articles

The Value of Ultrasonography in the Diagnosis of Abdominal Pregnancy.

Analyze the clinical and ultrasound characteristics of 15 cases of abdominal pregnancy (AP) to improve the ultrasonography-based diagnosis. A retrospective research of AP patients from 2010 to 2021 with pathology was performed, clinical and ultrasound characteristics were analyzed and summarized. Fifteen cases of AP occurred in early pregnancy. Most cases of AP were implanted in the pelvic cavity, with a few on the greater omentum and diaphragm, etc. Eight cases showed mixed hyperechoic, four cases had gestational sacs, and three cases exhibited mixed hypoechoic. Combined with the characteristics of AP, ultrasound can provide a valuable diagnosis.

Abdominal Pregnancy at Term a Rare Case Report from Jinnah Post Graduate Medical Centre Karachi, Pakistan

Abdominal pregnancy is an extreme rare situation and the quoted incidence is 1.4% of all ectopic pregnancies. The diagnosis and management is challenging and requires multidisciplinary input, if not managed in good hands can lead to serious consequences leading to maternal and neonatal mortality. We present a case of 32 years old abdominal pregnancy which presented to us at 31 weeks pregnancy with severe vomiting and mild abdominal pain. The site of pregnancy went unrecognized till 35 weeks pregnancy until she was operated in suspection of placenta Previa. The patient recovered smoothly after surgery and went home in stable condition. Abdominal pregnancy is challenging to diagnose and manage. It requires not only clinical expertise but also strong radiological guidance to advice management. A rare presentation of persistent nausea and vomiting due to compression of underlying intestines may lead to consider the diagnosis of abdominal pregnancy in later gestation

A Case Report: MRI versus Ultrasonography in Abdominal Pregnancy, Which One is Better?

Abdominal pregnancy is a rare potentially life-threatening form of ectopic pregnancy. First trimester sonography is very useful to identify an abdominal pregnancy earlier. However, cases of undiagnosed abdominal pregnancy at second and third trimesters are still reported in obstetric practice. Abdominal pregnancy is often missed during routine ultrasound examination that has classical findings such as the absence of myometrial tissue between the maternal bladder and the pregnancy, an empty uterus, poor visualization of the placenta, oligohydramnios, and abnormality of fetal lie. Magnetic Resonance Imaging (MRI) has been reported as the best abdominal pregnancy detection modality in a later gestational age due to its ability in detailing vascular and placental organ invasion. The reporting of a case of a patient with an abdominal pregnancy involves a diagnosis using abdominal ultrasound in the second trimester. A 38-year-old woman was admitted to RSUP Dr. Hasan Sadikin Bandung with suspected abdominal pregnancy at gestational age of 28 weeks. Due to unclear clinical manifestation, the diagnosis of abdominal pregnancy was not detected and there was a plan for vaginal termination of pregnancy by misoprostol induction in the hospital before. The patient complained about progressive abdominal pain and difficult of defecation for 2 months before and this condition worsened in the last 4 days. Ultrasound examination in RSHS revealed that there were one living fetus, extra-uterine pregnancy with estimated fetal weight of 664 grams, fetal heart rate (+), and transverse breech presentation. Congenital abnormality was difficult to assess due to oligohydramnios. MRI was performed and showed intra-abdomen pregnancy with one living fetus, breech presentation, and intact amniotic membrane with oligohydramnios which was superior to the uterus and attached along the anterior aspect of uterus. The placenta had the size os 11.52 x 7.02 x 13.07 cm, was diffusely heterogenous in shape, on the right superoanterolateral wall of the gestational sac, and seemed to be attached to the right anterior abdominal wall and part of the intestine in the superior part while no placental adherence was seen. The patient was successfully treated with exploratory laparotomy with complete removal of the fetus and placenta. This case was reported to compare the advantage of MRI and ultrasound examination in detecting abdominal pregnancy, especially in late gestational age.

Case report of ectopic pregnancy on transverse colon

Abdominal ectopic pregnancy is a rare form of ectopic pregnancy, and there are a few cases of colonic implantation reported in the literature. In this report, we describe a unique instance of transverse colonic large hematocele associated with degressive ectopic pregnancy. Patient concerns: A 30–year–old female patient suffered abdominal pain and digestive disorders and did not report any gynecological diseases. The only indicator to diagnose gestative condition was beta-HCG, which increased slightly from 415IU/L to 435IU/L after 2 weeks. Transvaginal ultrasonography shows no evidence of a gestational mass inside the uterus or in the cul-de-sac, which is a frequent site of ectopic pregnancy. But abdominal CT with contrast injection revealed a hyperdense mass measuring 50´53´101mm along the edge of the right colon. A diagnosis of abdominal pregnancy was suspected. Thus, the patient underwent explanatory laparoscopy to confirm the diagnosis and for the treatment. Pathological examination confirms the diagnosis of transverse colonic ectopic pregnancy. After a few days of uncomplicated recovery, the patient was cleared to return home. On the first day following surgery, the beta-HCG results decreased to 112IU/L, and additional testing produced negative results. Conclusion: Ectopic pregnancy may be implanted anywhere in the abdominal cavity even on the transverse colon. When diagnosing a female patient of reproductive age with an inexplicable rise or even low blood BetaHCG level, clinicians must consider the potential of abdominal ectopic pregnancy.

Secondary Abdominal Pregnancy at term: a case report

Abdominal pregnancy is a rare form of ectopic pregnancy and a serious form of extrauterine pregnancy. Abdominal pregnancy account for almost 1% of ectopic pregnancies. Rarely,it may reach at advanced gestation and a viable fetal outcome is a rare event. Sometimes, the diagnosis is suspected only when repeated attempts of induction of abortion or labor are unsuccessful. Really it is difficult to diagnose and manage. Here we are reporting a case of secondary abdominal pregnancy in a 27 years old primi gravida at 39+ weeks of gestation. It was observed from her ultrasonography that a single live pregnancy with breech presentation with almost absent liquor with IUGR baby then decision was made for lower uterine cesarean section under sub-arachnoid block. But it was turned into laparotomy and diagnosed as a secondary abdominal pregnancy. A healthy female baby was delivered. The placenta was attached with the omentum and large bowel loop. After tying and cutting the cord flushed with it's placental attachment, placenta was kept in situ. Abdomen was closed in layers. The diagnosis of abdominal pregnancy was made peroperatively with successful management and delivery of a healthy female baby.
 Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(2):104-106

Abdominal Cocoon Syndrome following Primary Subfertility Management with IVF-ET

Abdominal cocoon syndrome is a rarely encountered surgical emergency first described by Foo et al. in 1978. This condition is characterised by a thick fibrous membrane which encases the small bowel partially or completely. Diagnosis of this condition is usually made per operatively and the treatment of choice is surgical release of entrapped bowel. This is a case report of abdominal cocoon syndrome diagnosed during laparotomy done with the provisional diagnosis of abdominal pregnancy following In vitro fertilization- embryo transfer. A 30 Years lady was admitted at Kathmandu Medical College for suspected ovarian hyper stimulation syndrome following In vitro fertilization- embryo transfer. Conservative treatment was done as the first line of management. Failing this, she was treated surgically with the provisional diagnosis of abdominal pregnancy. Abdominal cocoon syndrome was observed intraoperatively. Patient was managed medically with injection due to raised βhCG level and empty uterine cavity. Intrauterine gestational sac was seen after about seven weeks of In vitro fertilization- embryo transfer. Pregnancy was terminated medically and patient was discharged. Sub fertility is a common gynecological problem. Its management may sometimes produce challenging health hazards. Thorough screening for medical and surgical illness is very important before proceeding to any kind of assisted reproductive technologies. A multidisciplinary approach is very important to manage such cases. Keywords: abdominal cocoon syndrome; embryo transfer; In Vitro fertilization; ovarian Hyper stimulation syndrome; sub fertility.

Simultaneous cul-de-sac and tubal pregnancy following in vitro fertilization

ObjectiveThe aim of this study is to share a valuable experience of heterotopic pregnancy following in vitro fertilization. Case reportA 37-year-old, gravida 3, para 2 (cesarean section 2 times), woman underwent in vitro fertilization with three embryos transferred. On Day 23 after the embryo transfer, right tubal pregnancy with a 0.7-cm gestational sac was found by ultrasound, and her serum β-human chorionic gonadotropin level was 81,388 mIU/mL. She underwent a laparotomy with right salpingectomy. On Day 43 after the embryo transfer, intermittent abdominal pains developed. A live fetus with a crown–rump length of 2.0 cm was found in the cul-de-sac. Under the diagnosis of abdominal pregnancy, she was admitted for sona-guided KCl and methotrexate injections. She received four units of packed red blood cells due to a drop in hemoglobin level from 12.5 g/dL to 8.6 g/dL. The patient recovered well, and the serum β-human chorionic gonadotropin declined to <10 mIU/mL. ConclusionVarious forms of ectopic pregnancy should be kept in mind in early pregnancy following in vitro fertilization.

Broad Ligament Pregnancy Through A Cesarean Scar : An Unusual One

Broad ligament pregnancy is an extremely rare event with high risk of maternal mortality. Diagnosis is often late in our setting and finally made during laparotomy. It is a type of secondary abdominal pregnancy.We present a case which remained undiagnosed throughout her pregnancy till she reached to 35 weeks and unfortunately had intrauterine fetal demise when she reported to our hospital.After admission her pregnancy was induced with misoprostol but did not response. On clinical suspicion,repeat ultrasound evaluation was done by senior sinologist, which picked up the diagnosis of abdominal pregnancy. On laparotomy a broad ligament pregnancy was found with a rent in the previous Cesarean scar towards the gestational sac in the broad ligament.Chatt Shi Hosp Med Coll J; Vol.15 (1); Jan 2016; Page 60-62

Broad Ligament Pregnancy: Lessons Learnt

ABSTRACT Abdominal pregnancy is a rare obstetric condition seen by the obstetricians. Its diagnosis is usually difficult and management is a matter of debate. A 39-year-old multigravida with 20 weeks gestation complicated by pregnancy-induced hypertension, diabetes mellitus and anemia with previous cesarean section was admitted. She was not aware of her pregnancy earlier and she desired termination of pregnancy. But, termination of pregnancy failed inspite of using all possible methods of inducing labor. Diagnosis of abdominal pregnancy was made on by transvaginal ultrasound and proceeded with laparotomy. Left broad ligament pregnancy was found and the sac with fetus extracted. However, due to uncontrollable bleeding from broad ligament during placenta separation and hysterectomy was proceeded in this lady. We present our experience with the diagnosis and management of this rare case. How to cite this article Agarwal P, Viswanath U, Rukshana, Natarajan MS. Broad Ligament Pregnancy: Lessons Learnt. J South Asian Feder Obst Gynae 2014;6(3):178-179.

Sudden death in advanced abdominal pregnancy: a case report and discussion of the related medicolegal issues

We report sudden unexpected death in a 35-year-old woman with pregnancy of seven months duration. There was an allegation by the parents of the woman that she was subjected to an assault prior to death. Autopsy examination showed an abdominal pregnancy with a dead fetus, ruptured gestational sac, massive haemorrhage and secondary placental attachment. During her antenatal check-ups, she had persistently complained of abdominal pain and loose stools, but the diagnosis of abdominal pregnancy was missed clinically and on ultrasound scan. In this paper we discuss the diagnostic difficulties and medicolegal issues in such cases.

Successful outcome in a near term Secondary Abdominal pregnancy presenting as Diagnostic Dilemma

Abdominal pregnancy is historically been defined as an implantation in the peritoneal cavity; exclusive of tubal, ovarian or intra ligamentary implantation. It is a rare form of ectopic pregnancy with an incidence of 1:8099 hospital deliveries and accounts for 1-4% of all ectopic pregnancies. The diagnosis of such a condition is missed during antenatal period despite the use of prenatal ultrasound. Newer advances, like use of MRI complement ultrasound in the diagnosis of abdominal pregnancy. We present an advanced case of secondary abdominal pregnancy which presented as placenta previa with fibroid uterus. The diagnosis was established after MRI scan. A live term baby was extracted after laparatomy and placenta was partially removed after ligating its blood supply. Mother and baby were healthy after such a catastrophic event. A review of the topic and management is also presented.

Full term broad ligament pregnancy through a Cesarean scar

A broad ligament pregnancy is an extremely rare condition. Diagnosis is often missed and finally made during laparotomy. We present a case which remained undiagnosed throughout her pregnancy till she reached term and unfortunately had intrauterine foetal demise when she reported to our hospital. On clinical suspicion, ultrasound and magnetic resonance imaging evaluation was done which picked up the diagnosis of abdominal pregnancy. On laparotomy a broad ligament pregnancy was found with a rent in the previous Cesarean scar towards the gestational sac in the broad ligament.

Abdominal Pregnancy: A Case Report And Review Of Literature

Abdominal pregnancy is a rare but potentially life – threatening form of extra uterine gestation. Diagnosis of abdominal pregnancy is difficult and often missed. A high index of suspicion is therefore required in makingthe diagnosis. This paper reports on a 22 year old nulliparous woman who presented with a 22 weeks secondary abdominal pregnancy. She had a laparotomy to remove the fetus and placenta. Her postoperativerecovery was uneventful.Key word – Abdominal pregnancy

Successful Laparoscopic Management of Primary Abdominal Pregnancy in the Cul-De-Sac

Summary Objective We report a rare case of primary abdominal pregnancy in the Douglas cul-de-sac that was successfully treated with laparoscopy. Case Report A 31-year-old primigravida woman had undergone intrauterine insemination 5 weeks prior to presentation. Ultrasound examination at presentation revealed an ectopic gestational sac in the cul-de-sac without any evidence of intrauterine pregnancy, and serum β-human chorionic gonadotropin (β-hCG) was 46,601 mIU/mL. Laparoscopy was performed and revealed an ectopic mass implanted in the cul-de-sac. The gestational tissue was removed by grasping forceps and hydrodissection. Bipolar electrocauterization and tamponading with Surgicel(tm) were used for hemostasis at the defect of the peritoneum. Serum β-hCG fell rapidly after surgery. The patient had a term baby delivered successfully 2 years postoperatively. Conclusion Early diagnosis of abdominal pregnancy enabled successful laparoscopic management.

Abdominal pregnancy: to remove or not to remove the placenta

Objective: The deleterious effect of abdominal pregnancy on the mother and fetus is in part related to the morbidity of the surgical interventions utilized in its treatment. The purpose of this study is to review outcome in abdominal pregnancy after surgical intervention. Study Design: Charts of patients diagnosed with abdominal pregnancy at our institution between 1984 and 1997 were reviewed. The identified cases were categorized as group I, placenta removed at surgery ( n = 10), and group II, placenta left in situ ( n = 4). Gestational age, maternal death, duration of hospital stay, blood transfusions, organ excisions, and postoperative readmissions were recorded. Student t test was used for statistical analysis with a P < .05 being significant. Results: Fourteen cases were identified ranging from 7 to 36 weeks of gestation. The diagnosis was made before laparotomy in 6 patients by imaging studies. There were no maternal deaths. Among the 9 in whom placenta was removed, 2 had salpingo-oophorectomy (S-O), 4 had total abdominal hysterectomy and bilateral S-O, and 5 received blood transfusions. One developed DIC requiring massive transfusion after a 7-week placenta was excised from the mesentery. This patient was hospitalized postoperatively for 5 months. In contrast, the 4 patients in whom the placenta was left in situ had neither blood transfusions nor removal of pelvic organs. Their hospital stay was shorter, group II, mean 9 ± 6 days versus group I, 34 ± 64 days, P = .0007. This difference was accounted for by the one prolonged hospitalization in group I. No patients in either group were readmitted. Conclusion: The diagnosis of abdominal pregnancy is often not made until laparotomy. Regardless of gestational age, placental excision can cause hemorrhage. Leaving the placenta in situ is potentially less costly and less morbid, and appears to shorten operative time and hospital stay while lowering risk of blood transfusion and of surgical menopause.

Advanced abdominal pregnancy: Difficulties in diagnosis

SummaryThe diagnosis of abdominal pregnancy can be difficult. The following cases are presented to describe clinical features which may raise the suspicion of this diagnosis. The continuation of such pregnancies carries significant risks for both mother and baby, and we review the literature on this subject in addition to highlighting clinical features which may indicate a subgroup of patients in whom a favourable outcome might be expected.

The value of ultrasound in the diagnosis of abdominal pregnancy

In some cases, it is very difficult to establish abdominal pregnancy according to a clinical examination. Ultrasound echography may play a leading role in the diagnosis of this pathology.We present our observation confirming the value of ultrasound in the diagnosis of full-term abdominal pregnancy.

Conjoined twins and abdominal pregnancy

Abdominal pregnancy is rare; conjoined twins are also rare. The diagnosis of abdominal pregnancy is easily missed and often not made until near full-term. Similarly conjoined twins are not diagnosed until late in gestation or during parturition. In this case, the diagnosis of conjoined twins and abdominal pregnancy was only made during laparotomy.

Abdominal pregnancy following gonadotropin treatment

An abdominal pregnancy after treatment with human menopausal and chorionic gonadotropins is reported. The role of induction of ovulation with human menopausal and chorionic gonadotropins as a cause of ectopic pregnancy has not been delineated. However, it appears that ultrasonography has become one of the most important aids in the diagnosis of abdominal pregnancy.

Radiological method in the diagnosis of ectopic pregnancy

An radiology examination of 59 women with ectopic pregnancies was carried out. 44 of them (group 1) had a tubal pregnancy in the ampulla, 8 (group 2) had a non-developing pregnancy in the accessory horn of the uterus (pregnancy duration from 12 to 20 weeks) and 7 (group 3) Abdominal pregnancy (in 6 secondary at 16 to 24 weeks and in 1 primary with a full-term dead fetus in the subhepatic region). The diagnosis of abdominal pregnancy was confirmed by X-ray examination using fractional cervicohysterosalpingography. Iodolipol, urotrast, and verografin were used as contrast agents.