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The Cochrane Database of Systematic... Jun 2012Abdominal decompression was developed as a means of pain relief during labour. It has also been used for complications of pregnancy, and in healthy pregnant women in an... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Abdominal decompression was developed as a means of pain relief during labour. It has also been used for complications of pregnancy, and in healthy pregnant women in an attempt to improve fetal wellbeing and intellectual development.
OBJECTIVES
The objective of this review was to assess the effects of prophylactic abdominal decompression on pregnancy outcomes such as admission for pre-eclampsia, fetal growth, perinatal morbidity and mortality and childhood development.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 February 2012).
SELECTION CRITERIA
Randomised trials comparing abdominal decompression with dummy decompression or no treatment in healthy pregnant women.
DATA COLLECTION AND ANALYSIS
Both review authors assessed eligibility and trial quality.
MAIN RESULTS
Three studies were included. There was no difference between the abdominal decompression groups and the control groups for low birthweight (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.27 to 1.77) and perinatal mortality (RR 2.47, 95% CI 0.77 to 7.92). There were no differences in admission for pre-eclampsia, Apgar score and childhood development.
AUTHORS' CONCLUSIONS
There is no evidence to support the use of abdominal decompression in normal pregnancies. Future research should be directed towards the use of abdominal decompression during labour, and during complicated pregnancies.
Topics: Child Development; Child, Preschool; Female; Humans; Lower Body Negative Pressure; Patient Dropouts; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Randomized Controlled Trials as Topic
PubMed: 22696321
DOI: 10.1002/14651858.CD001062.pub2 -
BMC Pregnancy and Childbirth Apr 2022Our previous study demonstrated the safety and effectiveness of abdominal radical trachelectomy during pregnancy but did not focus on the fetus. This study aimed to...
BACKGROUND
Our previous study demonstrated the safety and effectiveness of abdominal radical trachelectomy during pregnancy but did not focus on the fetus. This study aimed to clarify the influence of abdominal radical trachelectomy performed during pregnancy on the fetus.
METHODS
Eight cervical cancer patients who underwent abdominal radical trachelectomy at our hospital between February 2013 and August 2020 were enrolled in this study. To assess the peri- and postoperative influence on the fetus, we performed fetal heart monitoring at 30-min intervals during abdominal radical trachelectomy and calculated the estimated fetal body weight and resistance indexes of the middle cerebral artery and umbilical artery from postsurgery until delivery.
RESULTS
Four out of eight patients had preterm birth due to chorioamnionitis in one case and consideration of the recurrent risk of cervical cancer in three cases. Fetal heart monitoring during abdominal radical trachelectomy revealed deceleration just once in one case but no abnormal findings in the other cases. In all cases, the fetal growth after abdominal radical trachelectomy was normal until delivery. No abnormal Doppler findings were detected in the middle cerebral artery or umbilical artery.
CONCLUSION
Our findings clarified that abdominal radical trachelectomy performed for the treatment of early-stage cervical cancer during pregnancy has no obvious influence on fetal growth. Next, it is necessary to evaluate the growth and development of children delivered from mothers who have undergone abdominal radical trachelectomy during pregnancy.
Topics: Child; Female; Fetus; Humans; Infant, Newborn; Pregnancy; Pregnancy Trimester, Second; Premature Birth; Trachelectomy; Uterine Cervical Neoplasms
PubMed: 35443666
DOI: 10.1186/s12884-022-04671-6 -
JSLS : Journal of the Society of... 2016Cervical insufficiency is a difficult condition to diagnose and can lead to preterm birth, miscarriage, or perinatal infant morbidity and mortality. We conducted this...
BACKGROUND AND OBJECTIVES
Cervical insufficiency is a difficult condition to diagnose and can lead to preterm birth, miscarriage, or perinatal infant morbidity and mortality. We conducted this retrospective case study and literature review to evaluate the safety and efficacy of robot-assisted abdominal cerclage during pregnancy.
METHODS
We conducted a case series and a systematic review that included patients who underwent robot-assisted abdominal cerclage during pregnancy from January 2010 through March 2016.
RESULTS
Six patients met the criteria for the case series. Median age was 34 years (range, 28-37) at the time of the procedure. In 5 cases, the indication for transabdominal cerclage was a failed vaginal cerclage in a previous pregnancy, whereas a scarred and shortened cervix caused by a previous dilatation and curettage-induced cervical laceration was the indication in the remaining case. Median operating time was 159.5 minutes (range, 124-204), and median estimated blood loss was 25 mL (range, 10-25). No surgeries were converted to laparotomies; all patients were discharged on postoperative day 1. The median gestational age at delivery was 37.5 weeks (range, 22-39). Five patients delivered between 36 and 39 weeks. No patients had chorioamnionitis or preterm premature rupture of membranes. One patient went into preterm labor at 22 weeks, and the cerclage was removed via minilaparotomy. Eight articles met the criteria for systematic review. Sixteen patients underwent robot-assisted abdominal cerclage during pregnancy. Median age was 31.5 years (range, 25-37). The major indication in most articles was previous failed transvaginal cerclage. The median gestational ages at time of procedure and delivery were 12 weeks (range, 10-15) and 37 weeks (range, 33-39), respectively.
CONCLUSION
Robot-assisted abdominal cerclage is safe and effective during pregnancy.
Topics: Adult; Cerclage, Cervical; Female; Gestational Age; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Retrospective Studies; Robotics; Uterine Cervical Incompetence
PubMed: 27904309
DOI: 10.4293/JSLS.2016.00072 -
International Journal of Surgery Case... Feb 2024Abdominal pregnancies, although rare, present unique challenges in both diagnosis and management. This case series reports on four cases of abdominal pregnancies...
INTRODUCTION AND IMPORTANCE
Abdominal pregnancies, although rare, present unique challenges in both diagnosis and management. This case series reports on four cases of abdominal pregnancies diagnosed in a remote and underserved region of the Democratic Republic of Congo, highlighting the difficulties encountered in an under-equipped environment.
CASE PRESENTATION
The cases were documented in a remote village of DRC, which lacks specialized medical personnel and relies heavily on traditional healers. We report here 4 cases of abdominal pregnancies, their clinical presentations, diagnostic modalities, and surgical approaches. The cases varied in terms of clinical symptoms, gestational age, and placental implantation sites. Delayed diagnosis and presentation were common, resulting in significant hemoperitoneum and adverse fetal outcomes. All cases required laparotomy for both diagnosis and intervention.
CLINICAL DISCUSSION
Abdominal pregnancies can go undetected until advanced gestational age, with common physical findings including abdominal tenderness, abnormal fetal lie, fetal body parts readily palpable, and a displaced cervix. Laboratory tests may raise suspicion, but treatment options depend on intraoperative findings and gestational age. Advanced abdominal pregnancies are associated with high mortality rates for both the mother and the fetus. Laparotomy is typically required for diagnosis and intervention, with variations in placental implantation sites. Management of the placenta remains a debated topic, with partial or complete removal both viable options.
CONCLUSION
Abdominal pregnancies pose significant challenges in resource-poor settings, where limited healthcare resources and a shortage of specialized medical personnel can impede early diagnosis and appropriate management. Enhancing prenatal care, improving diagnostic capabilities, and increasing awareness among healthcare providers and communities are essential for optimizing outcomes in these complex obstetric cases.
PubMed: 38306869
DOI: 10.1016/j.ijscr.2024.109282 -
Annals of Intensive Care Jul 2012The last several decades have seen many advances in the recognition and prevention of the abdominal compartment syndrome (ACS) and its precursor, intra-abdominal...
The last several decades have seen many advances in the recognition and prevention of the abdominal compartment syndrome (ACS) and its precursor, intra-abdominal hypertension (IAH). There has also been a relative explosion of knowledge in the critical care, trauma, and surgical populations, and the inception of a society dedicated to its understanding, the World Society of the Abdominal Compartment Syndrome (WSACS). However, there has been almost no recognition or appreciation of the potential presence, influence, and management of intra-abdominal pressure (IAP), IAH, and ACS in pregnancy. This review highlights the importance and relevance of IAP in the critically ill parturient, the current lack of normative IAP values in pregnancy today, along with a review of the potential relationship between IAH and maternal diseases such as preeclampsia-eclampsia and its potential impact on fetal development. Finally, current IAP measurement guidelines are questioned, as they do not take into account the gravid uterus and its mechanical impact on intra-vesicular pressure.
PubMed: 22873421
DOI: 10.1186/2110-5820-2-S1-S5 -
BMJ Case Reports Feb 2022Uterosacral ligament (USL) is an uncommon site of implantation for abdominal ectopic pregnancies. This is the first case of USL heterotopic pregnancy post invitro...
Uterosacral ligament (USL) is an uncommon site of implantation for abdominal ectopic pregnancies. This is the first case of USL heterotopic pregnancy post invitro fertilisation (IVF). The patient presented 6 weeks after a double embryo transfer with acute onset abdominal pain and was diagnosed with a suspected live tubal ectopic pregnancy with a viable intrauterine pregnancy on ultrasound. A diagnostic laparoscopy revealed an ectopic pregnancy implanted on the left USL which was resected and confirmed on histology. The patient was discharged well on postoperative day 2 with a viable intrauterine pregnancy. This case highlights the importance of considering non-tubal heterotopic pregnancies in the context of risk factors including IVF with double embryo transfer presenting with abdominal pain.
Topics: Embryo Transfer; Female; Fertilization in Vitro; Humans; Pregnancy; Pregnancy, Abdominal; Pregnancy, Heterotopic; Pregnancy, Tubal
PubMed: 35131787
DOI: 10.1136/bcr-2021-246649 -
International Journal of Surgery Case... 2018Acute appendicitis is the main indication for surgery during pregnancy. Physiologic changes during pregnancy and fear of using ionising radiation exams are some of the...
INTRODUCTION
Acute appendicitis is the main indication for surgery during pregnancy. Physiologic changes during pregnancy and fear of using ionising radiation exams are some of the reasons to delayed diagnosis and consequently to higher morbidity and mortality rates for mother and fetus.
PRESENTATION OF CASE
We present the case of a 38-year-old woman that resorted to the emergency room on the 13th week of pregnancy with abdominal discomfort, nausea and vomiting that lasted for 7 days. She had been in the Obstetric Emergency Department 6 days prior with the same complaints. She had no fever and she was discharged home following normal obstetric ultrasound. On this second visit, after surgical consultation, septic shock with abdominal source was recognised and patient was taken for emergency exploratory laparotomy. Intraoperatively we found generalised purulent peritonitis secondary to perforated acute appendicitis. Appendectomy, thorough abdominal washing and laparostomy were performed. Patient was admitted on the Intensive Care Unit with septic shock, need for vasopressor therapy and dialysis. Four days after the first intervention the abdominal cavity was closed. She was discharged home on the 14th post-operative day and maintained obstetric follow-up for the remaining uncomplicated pregnancy.
DISCUSSION
In the presented clinical case, diagnostic delay evolves to abdominal sepsis that demanded a damage control approach. Laparostomy constitutes a damage control gesture, limiting abdominal contamination, preventing abdominal compartment syndrome and allowing subsequent surgical revisions.
CONCLUSION
Acute abdominal approach using laparostomy allowed for a good outcome, maintaining ongoing pregnancy and with incisional hernia as the only observed morbidity.
PubMed: 30149329
DOI: 10.1016/j.ijscr.2018.08.029 -
Reproductive Biology and Endocrinology... Oct 2016Ectopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with assisted-reproductive... (Review)
Review
BACKGROUND
Ectopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with assisted-reproductive technology (ART), occurring in approximately 1.5-2.1 % of patients undergoing in-vitro fertilization (IVF). Abdominal ectopic pregnancy is a rare yet clinically significant form of ectopic pregnancy due to potentially high maternal morbidity. While risk factors for ectopic pregnancy after IVF have been studied, very little is known about risk factors specific for abdominal ectopic pregnancy. We present a case of a 30 year-old woman who had an abdominal ectopic pregnancy following IVF and elective single embryo transfer, which was diagnosed and managed by laparoscopy. We performed a systematic literature search to identify case reports of abdominal or heterotopic abdominal ectopic pregnancies after IVF. A total of 28 cases were identified.
RESULTS
Patients' ages ranged from 23 to 38 (Mean 33.2, S.D. = 3.2). Infertility causes included tubal factor (46 %), endometriosis (14 %), male factor (14 %), pelvic adhesive disease (7 %), structural/DES exposure (7 %), and unexplained infertility (14 %). A history of ectopic pregnancy was identified in 39 % of cases. A history of tubal surgery was identified in 50 % of cases, 32 % cases having had bilateral salpingectomy. Transfer of two embryos or more (79 %) and fresh embryo transfer (71 %) were reported in the majority of cases. Heterotopic abdominal pregnancy occurred in 46 % of cases while 54 % were abdominal ectopic pregnancies.
CONCLUSIONS
Our systematic review has revealed several trends in reported cases of abdominal ectopic pregnancy after IVF including tubal factor infertility, history of tubal ectopic and tubal surgery, higher number of embryos transferred, and fresh embryo transfers. These are consistent with known risk factors for ectopic pregnancy following IVF. Further research focusing on more homogenous population may help in better characterizing this rare IVF complication and its risks.
Topics: Adult; Female; Fertilization in Vitro; Humans; Infertility, Male; Laparoscopy; Male; Pregnancy; Pregnancy, Abdominal; Pregnancy, Ectopic; Risk Factors; Single Embryo Transfer
PubMed: 27760569
DOI: 10.1186/s12958-016-0201-x -
The American Surgeon Apr 2024Previous studies suggest increased abdominal girth in obese individuals provides a "cushion effect," against severe abdominal trauma. In comparison, the unique...
BACKGROUND
Previous studies suggest increased abdominal girth in obese individuals provides a "cushion effect," against severe abdominal trauma. In comparison, the unique anatomic/physiological condition of pregnancy, such as the upward displacement of organs by an expanding uterus, may decrease risk of abdominal injury. However, increased overall blood volume and vascularity of organs during pregnancy raise concerns for increased bleeding and potentially more severe injuries. Therefore, this study aimed to elucidate whether the "cushion effect" observed in obese patients extends to pregnant trauma patients (PTPs). We hypothesized a lower risk of blunt solid organ injury (BSOI) (liver, spleen, and kidney) in pregnant vs non-pregnant blunt trauma patients.
METHODS
The 2020-2021 Trauma Quality Improvement Program was queried for all female blunt trauma patients (age<50 years) involved in motor vehicle collisions (MVCs). We compared pregnant vs non-pregnant patients. The primary outcomes were incidence of BSOI, and severity of abdominal trauma defined by abbreviated injury scale (AIS).
RESULTS
From 94,831 female patients, 2598 (2.7%) were pregnant. When compared to non-pregnant patients, PTPs had lower rates of liver (5.5% vs 7.6%, < .001) and kidney (1.8% vs 2.6%, = .013) injury. However, PTPs had higher rates of serious (13.4% vs 9.0%, < .001) and severe abdominal injury (7.5% vs 4.3%, < .001).
DISCUSSION
BSOI occurred at a lower rate in PTPs compared to non-PTPs; however, contrary to the "cushion effect" observed in obese populations, pregnant women had a higher rate of severe abdominal injuries. These data support comprehensive evaluations for PTPs presenting after a MVC.
LEVEL OF EVIDENCE
IV (therapeutic).
PubMed: 38676625
DOI: 10.1177/00031348241248790 -
Radiology Case Reports Dec 2023Abdominal pregnancy is a very rare form of ectopic gestation in which implantation occurs in the peritoneal cavity. It accounts for about 1% of all ectopic pregnancies...
Abdominal pregnancy is a very rare form of ectopic gestation in which implantation occurs in the peritoneal cavity. It accounts for about 1% of all ectopic pregnancies and is associated with a higher risk of morbidity and mortality due to complications such as preeclampsia, placenta abruption, and oligohydromnios, which necessitate pregnancy termination before term, and the risk of massive hemorrhage associated with abnormal placentation. We present a case of advanced abdominal ectopic pregnancy, diagnosed in the second trimester and complicated by anhydramnios. An abdominal ultrasound scan showed a nongravid uterus and a single live extrauterine fetus within the abdominal cavity, with no surrounding liquor at 23 weeks and 3 days average gestational age. Mother was consented and an emergency laparatomy performed. A premature baby was delivered but died in Neonatal Intensive Care Unit (NICU) after 4 hours due to severe acute respiratory distress syndrome. Mother had good postoperative recovery. Advanced abdominal ectopic pregnancy though very rare, is associated with complications that lead to early termination. Ultrasound scan is a reliable tool for the diagnosis of abdominal pregnancy in settings with limited access to Magnetic Resonance Imaging (MRI). It should be recommended to all mothers at their earliest antenatal care (ANC) visit to help determine the site of pregnancy and guide further intervention.
PubMed: 37840888
DOI: 10.1016/j.radcr.2023.09.042