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The New England Journal of Medicine Dec 2023
Topics: Female; Humans; Pregnancy; Abdomen; Pregnancy, Abdominal
PubMed: 38078501
DOI: 10.1056/NEJMicm2120220 -
Harefuah Feb 2017Abdominal pregnancy is a very rare obstetric complication which is seriously hazardous to the mother as well as the fetus. It poses a diagnostic challenge to this day.... (Review)
Review
Abdominal pregnancy is a very rare obstetric complication which is seriously hazardous to the mother as well as the fetus. It poses a diagnostic challenge to this day. Both maternal and fetal mortality rates in such cases are high, as well as the malformation rate among the affected fetus. The best diagnostic tools are ultrasound and MRI. The availability of these instruments, and especially the latter, is scarce in developing countries, hence the higher rate of this type of pregnancy in these regions. The higher incidence of abdominal pregnancy in developing countries is also associated with the greater prevalence of low socioeconomic status, pelvic infections and infertility - all are more prevalent in these countries. Abdominal pregnancy may be primary - that is fertilization of an ovum in the abdominal cavity, or secondary - re-implantation following tubal abortion, perforation of the uterine wall during curettage or expulsion of pregnancy material through uterine rupture or dehiscence. Heterotopic pregnancies, in which one or both fetuses are found as abdominal pregnancy have been reported. Treatment is surgery. The issue of removing the placenta during the operation is controversial to this day. Treatment of the remaining placenta with methotrexate has recently been abandoned. Lately, conservative treatment by potassium chloride (KCl) injection to the fetal heart by sonographic guidance has been suggested.
Topics: Abortion, Spontaneous; Female; Fetal Heart; Humans; Infertility; Pregnancy; Pregnancy, Abdominal; Uterus
PubMed: 28551894
DOI: No ID Found -
BMJ Case Reports Sep 2023An ectopic pregnancy (EP) accounts for 1-2% of all pregnancies, of which 90% implant in the fallopian tube. An abdominal ectopic pregnancy (AEP) is defined as an ectopic...
An ectopic pregnancy (EP) accounts for 1-2% of all pregnancies, of which 90% implant in the fallopian tube. An abdominal ectopic pregnancy (AEP) is defined as an ectopic pregnancy occurring when the gestational sac is implanted in the peritoneal cavity outside the uterine cavity or the fallopian tube. Implantation sites may include the omentum, peritoneum of the pelvic and abdominal cavity, the uterine surface and abdominal organs such as the spleen, intestine, liver and blood vessels. Primary abdominal pregnancy results from fertilisation of the ovum in the abdominal cavity and secondary occurs from an aborted or ruptured tubal pregnancy. It represents a very rare form of an EP, occurring in <1% of cases. At early gestations, it can be challenging to render the diagnosis, and it can be misdiagnosed as a tubal ectopic pregnancy. An AEP diagnosed >20 weeks' gestation, caused by the implantation of an abnormal placenta, is an important cause of maternal-fetal mortality due to the high risk of a major obstetric haemorrhage and coagulopathy following partial or total placental separation. Management options include surgical therapy (laparoscopy±laparotomy), medical therapy with intramuscular or intralesional methotrexate and/or intracardiac potassium chloride or a combination of medical and surgical management. The authors present the case of a multiparous woman in her early 30s presenting with heavy vaginal bleeding and abdominal pain at 8 weeks' gestation. Her beta-human chorionic gonadotropin (bHCG) was 5760 IU/L (range: 0-5), consistent with a viable pregnancy. Her transvaginal ultrasound scan suggested an ectopic pregnancy. Laparoscopy confirmed an AEP involving the pelvic lateral sidewall. Her postoperative 48-hour bHCG was 374 IU/L. Due to the rarity of this presentation, a high index of clinical suspicion correlated with the woman's symptoms; bHCG and ultrasound scan is required to establish the diagnosis to prevent morbidity and mortality.
Topics: Pregnancy; Female; Humans; Pregnancy, Abdominal; Placenta; Chorionic Gonadotropin, beta Subunit, Human; Pregnancy, Tubal; Methotrexate
PubMed: 37775278
DOI: 10.1136/bcr-2022-252960 -
International Journal of Gynaecology... Oct 1993Two cases of Abdominal pregnancy are reported: one from the Castle Street Hospital for Women, Colombo, Sri-Lanka and the other from the Queen Elizabeth Hospital,... (Review)
Review
Two cases of Abdominal pregnancy are reported: one from the Castle Street Hospital for Women, Colombo, Sri-Lanka and the other from the Queen Elizabeth Hospital, Barbados, West Indies. The clinical manifestations, diagnosis and management are described. A review of the literature is presented.
Topics: Adult; Female; Humans; Laparotomy; Pregnancy; Pregnancy, Abdominal
PubMed: 7904955
DOI: 10.1016/0020-7292(93)90274-z -
Obstetrical & Gynecological Survey Aug 1991
Review
Topics: Diagnostic Imaging; Female; History, 16th Century; History, 19th Century; History, 20th Century; History, Ancient; Humans; Incidence; Pregnancy; Pregnancy, Abdominal
PubMed: 1886705
DOI: 10.1097/00006254-199108000-00003 -
Archives of Gynecology and Obstetrics Jul 2018Advanced abdominal pregnancy is a highly morbid form of extrauterine gestation that demands skilled management. Despite advancement in antenatal care and imaging... (Review)
Review
BACKGROUND
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 + 4 weeks 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.
METHODOLOGY
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.
RESULTS
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%.
CONCLUSION
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.
Topics: Abdominal Pain; Cesarean Section; Consensus; Female; Humans; Live Birth; Pregnancy; Pregnancy Outcome; Pregnancy, Abdominal
PubMed: 29550945
DOI: 10.1007/s00404-018-4743-3 -
BMC Pregnancy and Childbirth Jun 2023Pregnancy begins with a fertilized ovum that normally attaches to the uterine endometrium. However, an ectopic pregnancy can occur when a fertilized egg implants and...
BACKGROUND
Pregnancy begins with a fertilized ovum that normally attaches to the uterine endometrium. However, an ectopic pregnancy can occur when a fertilized egg implants and grows outside the uterine cavity. Tubal ectopic pregnancy is the most common type (over 95%), with ovarian, abdominal, cervical, broad ligament, and uterine cornual pregnancy being less common. As more cases of ectopic pregnancy are diagnosed and treated in the early stages, the survival rate and fertility retention significantly improve. However, complications of abdominal pregnancy can sometimes be life-threatening and have severe consequences.
CASE PRESENTATION
We present a case of intraperitoneal ectopic pregnancy with fetal survival. Ultrasound and magnetic resonance imaging showed a right cornual pregnancy with a secondary abdominal pregnancy. In September 2021, we performed an emergency laparotomy, along with additional procedures such as transurethral ureteroscopy, double J-stent placement, abdominal fetal removal, placentectomy, repair of the right uterine horn, and pelvic adhesiolysis, in the 29th week of pregnancy. During laparotomy, we diagnosed abdominal pregnancy secondary to a rudimentary uterine horn. The mother and her baby were discharged eight days and 41 days, respectively, after surgery.
CONCLUSIONS
Abdominal pregnancy is a rare condition. The variable nature of ectopic pregnancy can cause delays in timely diagnosis, resulting in increased morbidity and mortality, especially in areas with inadequate medical and social services. A high index of suspicion, coupled with appropriate imaging studies, can help facilitate its diagnosis in any suspected case.
Topics: Pregnancy; Female; Humans; Pregnancy, Abdominal; Pregnancy, Cornual; Uterus; Pregnancy, Tubal; Ultrasonography
PubMed: 37270533
DOI: 10.1186/s12884-023-05704-4 -
The Journal of Obstetrics and... Oct 2023The abdominal wall is a rare site of ectopic implantation. Laparoscopic surgery for early abdominal pregnancy, in contrast to its use for tubal ectopic pregnancy,... (Review)
Review
The abdominal wall is a rare site of ectopic implantation. Laparoscopic surgery for early abdominal pregnancy, in contrast to its use for tubal ectopic pregnancy, remains controversial because of concerns regarding heavy bleeding at the implantation site. Treatment of early abdominal pregnancy must be individualized for each implantation site. Herein, we present a case of an early abdominal pregnancy implanted in the anterior abdominal wall that was successfully treated with laparoscopic surgery. A 28-year-old multiparous woman with a 6-week amenorrhea presented with acute abdominal pain. An ectopic pregnancy was suspected because of elevated serum human chorionic gonadotropin levels without a visible gestational sac on transvaginal ultrasonography. Diagnostic laparoscopy revealed a gestational sac hanging from the anterior abdominal wall near the previous cesarean section wound. Laparoscopic surgery was successfully performed, and the patient was discharged on postoperative day three. In the present case, laparoscopic surgery was beneficial.
Topics: Pregnancy; Humans; Female; Adult; Pregnancy, Abdominal; Cesarean Section; Abdominal Wall; Pregnancy, Tubal; Laparoscopy
PubMed: 37424208
DOI: 10.1111/jog.15739 -
European Journal of Obstetrics,... Sep 2020
Topics: Female; Humans; Pregnancy; Pregnancy, Abdominal
PubMed: 32631684
DOI: 10.1016/j.ejogrb.2020.06.050 -
The Journal of Obstetrics and... Oct 2021We report the case of a 36-year-old woman with spontaneously conceived heterotopic pregnancy with abdominal pregnancy. She visited the hospital at 5 weeks and 4 days... (Review)
Review
We report the case of a 36-year-old woman with spontaneously conceived heterotopic pregnancy with abdominal pregnancy. She visited the hospital at 5 weeks and 4 days of gestation and transvaginal ultrasonography revealed a normal intrauterine pregnancy. Two days later, she was urgently transported to the hospital due to extreme abdominal pain. Emergent laparotomy was performed to investigate the cause of massive intraperitoneal bleeding, which was confirmed to have been due to an abdominal pregnancy that implanted on the vesicouterine pouch. The hematic mass, including chorionic villi, was successfully removed from the peritoneum. The subsequent course of the intrauterine pregnancy was uneventful and a healthy baby was born at term. To the best of our knowledge, this is an extremely rare case report of a spontaneously conceived heterotopic abdominal pregnancy, in which the intrauterine pregnancy showed a successful outcome despite the collapse of the abdominal pregnancy at a very early stage.
Topics: Adult; Chorionic Villi; Female; Humans; Peritoneum; Pregnancy; Pregnancy, Abdominal; Pregnancy, Heterotopic
PubMed: 34342369
DOI: 10.1111/jog.14967