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A pre-operatively diagnosed advanced abdominal pregnancy with a surviving neonate: a case report.

Gudu W, Bekele D - J Med Case Rep (2015)

Bottom Line: Her laboratory test results were unremarkable except for mild anemia.This is particularly important in areas where advanced imaging technologies are not readily available.Timely surgical intervention is imperative to avert maternal and fetal complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics & Gynecology, Karamara Regional Referral Hospital, P.O. Box 238, Jigjiga, Somali Regional State, Ethiopia. wondgu@yahoo.com.

ABSTRACT

Introduction: Abdominal pregnancy is a rare form of ectopic pregnancy with a high rate of maternal and fetal complications. Most of the reported cases are diagnosed in early trimesters, usually after presenting with complications. Advanced abdominal pregnancy poses a huge diagnostic and management challenge, particularly in low-income countries. A term abdominal pregnancy diagnosed pre-operatively and resulting in a surviving neonate is quite rare.

Case presentation: A 35-year-old, para 2, unbooked, Ethiopian Somali woman presented with amenorrhea of 9 months' duration, abdominal pain, and painful fetal movements of 4 months' duration. Her physical examination revealed a uterus sized 36 weeks' gestation with easily palpable fetal parts. Her laboratory test results were unremarkable except for mild anemia. Her ultrasound findings were suggestive of abdominal pregnancy. Laparotomy was done to salvage an alive healthy neonate from the peritoneum with removal of placenta implanted on the right broad ligament. The mother had a smooth post-operative course.

Conclusions: An advanced abdominal pregnancy diagnosed pre-operatively with delivery of a surviving neonate is rare. A high index of suspicion and thorough clinical and ultrasound evaluation are crucial to making an early diagnosis. This is particularly important in areas where advanced imaging technologies are not readily available. Timely surgical intervention is imperative to avert maternal and fetal complications.

No MeSH data available.


Related in: MedlinePlus

Photograph showing the implantation of the placenta on the right broad ligament
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Fig2: Photograph showing the implantation of the placenta on the right broad ligament

Mentions: The woman was counseled on the diagnosis, and informed consent was obtained for surgery. After securing 4 U of whole blood, laparotomy was done through a subumbilical midline incision that revealed the following findings: an alive, meconium-stained male neonate retrieved free from the peritoneum, weighing 2600g, and having Apgar scores of 7 and 9 in the first and fifth minutes, respectively. The baby had no gross congenital anomalies. The movie file in Additional file 1 shows the surgical procedure in detail. Fine adhesions involving the placental membranes, the omentum, and part of ileum obscured access to the pelvic cavity. Adhesiolysis revealed a fragile placenta localized in the right adnexa with a network of engorged vascular communications with the right ovarian, fallopian tube, and broad ligament vessels. The fimbrial end of the right tube was distorted and embedded in the base of the placenta (Fig. 2). The uterus was enlarged but otherwise normal-looking and intact (Fig. 3). Both ovaries and the left fallopian tube were normal. Right salpingectomy and ligation and transfixion of the vessels at the base of the placenta were done to remove the placenta completely without causing significant bleeding. An abdominal drain was left in situ. The patient was transfused with 2 U of whole blood. Both the woman and the neonate had smooth post-operative courses and were discharged on the fifth post-operative day.Fig. 2


A pre-operatively diagnosed advanced abdominal pregnancy with a surviving neonate: a case report.

Gudu W, Bekele D - J Med Case Rep (2015)

Photograph showing the implantation of the placenta on the right broad ligament
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4597396&req=5

Fig2: Photograph showing the implantation of the placenta on the right broad ligament
Mentions: The woman was counseled on the diagnosis, and informed consent was obtained for surgery. After securing 4 U of whole blood, laparotomy was done through a subumbilical midline incision that revealed the following findings: an alive, meconium-stained male neonate retrieved free from the peritoneum, weighing 2600g, and having Apgar scores of 7 and 9 in the first and fifth minutes, respectively. The baby had no gross congenital anomalies. The movie file in Additional file 1 shows the surgical procedure in detail. Fine adhesions involving the placental membranes, the omentum, and part of ileum obscured access to the pelvic cavity. Adhesiolysis revealed a fragile placenta localized in the right adnexa with a network of engorged vascular communications with the right ovarian, fallopian tube, and broad ligament vessels. The fimbrial end of the right tube was distorted and embedded in the base of the placenta (Fig. 2). The uterus was enlarged but otherwise normal-looking and intact (Fig. 3). Both ovaries and the left fallopian tube were normal. Right salpingectomy and ligation and transfixion of the vessels at the base of the placenta were done to remove the placenta completely without causing significant bleeding. An abdominal drain was left in situ. The patient was transfused with 2 U of whole blood. Both the woman and the neonate had smooth post-operative courses and were discharged on the fifth post-operative day.Fig. 2

Bottom Line: Her laboratory test results were unremarkable except for mild anemia.This is particularly important in areas where advanced imaging technologies are not readily available.Timely surgical intervention is imperative to avert maternal and fetal complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics & Gynecology, Karamara Regional Referral Hospital, P.O. Box 238, Jigjiga, Somali Regional State, Ethiopia. wondgu@yahoo.com.

ABSTRACT

Introduction: Abdominal pregnancy is a rare form of ectopic pregnancy with a high rate of maternal and fetal complications. Most of the reported cases are diagnosed in early trimesters, usually after presenting with complications. Advanced abdominal pregnancy poses a huge diagnostic and management challenge, particularly in low-income countries. A term abdominal pregnancy diagnosed pre-operatively and resulting in a surviving neonate is quite rare.

Case presentation: A 35-year-old, para 2, unbooked, Ethiopian Somali woman presented with amenorrhea of 9 months' duration, abdominal pain, and painful fetal movements of 4 months' duration. Her physical examination revealed a uterus sized 36 weeks' gestation with easily palpable fetal parts. Her laboratory test results were unremarkable except for mild anemia. Her ultrasound findings were suggestive of abdominal pregnancy. Laparotomy was done to salvage an alive healthy neonate from the peritoneum with removal of placenta implanted on the right broad ligament. The mother had a smooth post-operative course.

Conclusions: An advanced abdominal pregnancy diagnosed pre-operatively with delivery of a surviving neonate is rare. A high index of suspicion and thorough clinical and ultrasound evaluation are crucial to making an early diagnosis. This is particularly important in areas where advanced imaging technologies are not readily available. Timely surgical intervention is imperative to avert maternal and fetal complications.

No MeSH data available.


Related in: MedlinePlus