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Tresch C, Lallemant M, Mottet N, Ramanah R. Placental preservation after surgery of an advanced ovarian pregnancy. J Gynecol Obstet Hum Reprod 2022; 51:102469. [DOI: 10.1016/j.jogoh.2022.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 11/15/2022]
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Muroni M, Butoyi JMV, Shimirimana M, Mulemangabo M, Nkurunziza J, Caravaggi P. Hemoperitoneum during removal of the placenta in advanced abdominal pregnancy with live fetus delivered at 37 weeks of gestation. A case report in a low-resource setting and literature review. Int J Surg Case Rep 2021; 80:105694. [PMID: 33676289 PMCID: PMC7982487 DOI: 10.1016/j.ijscr.2021.105694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Advanced abdominal pregnancy (> 20 weeks gestation) is a rare condition life-threatening for mother and fetus. CASE PRESENTATION A 31-years-old African woman presented from a rural district to Mutoyi Hospital for first gynecological evaluation after 37 weeks of amenorrhea, abdominal pain and vaginal bleeding. An ultrasound revealed an extra-uterine fetus. Laparotomy was done and a live fetus weighing 1980 g was delivered. Removal of the placenta, triggered massive bleeding (5000 mL) with shock. After re-laparotomy for post-operative ileus and hemoperitoneum, the mother and infant were discharged in good health. CLINICAL DISCUSSION Viable fetus can be delivered after an advanced abdominal pregnancy. Removal of the placenta is controversial. We review currently medical literature on advanced abdominal pregnancy and propose a management of the placenta in these patients. CONCLUSION We recommended to leave the placenta in situ, to avoid intraoperative bleeding. Placenta involution during follow-up can be revealed by ultrasound, colordoppler and β-hCG serum level decrease.
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Affiliation(s)
- Mirko Muroni
- Mutoyi Hospital, General Surgery Department, Gitega, Burundi.
| | | | | | | | - Joel Nkurunziza
- Mutoyi Hospital, General Surgery Department, Gitega, Burundi
| | - Paola Caravaggi
- Mutoyi Hospital, Obstetrics and Gynecology Department, Gitega, Burundi
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Hymel JA, Hughes DS, Gehlot A, Ramseyer AM, Magann EF. Late Abdominal Pregnancies (≥20 Weeks Gestation): A Review from 1965 to 2012. Gynecol Obstet Invest 2015; 80:253-8. [PMID: 25924581 DOI: 10.1159/000381264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 02/26/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Information about the diagnosis and management of late abdominal pregnancies (≥20 weeks gestation) is limited to case reports and small case series. METHODS We performed a literature review of abdominal pregnancies ≥20 weeks gestation from 1965 to November 2012. Excluded were abdominal ectopic pregnancies that did not primarily implant in the peritoneal cavity, including tubal, ovarian, and intraligamentary pregnancies, and those prior to 20 weeks gestation. RESULTS The 31 cases identified were at 30.4 ± 7.4 weeks at diagnosis and 33 ± 8.3 weeks at delivery. The most common sites of placental implantation were uterus or adnexa (47.8%), bowel (30%), and the potential spaces surrounding the uterus (8.7%). There were 5 cases of an intra-abdominal abscess in the 14 patients in whom the placenta had been left in situ. Maternal outcomes were documented in 26 cases with 7 deaths; 27 fetal outcomes were documented in 22 cases with 3 fetal deaths (13.6%). CONCLUSION An abdominal ectopic pregnancy is an uncommon but serious event and should be considered in all patients until intrauterine gestation is confirmed. Management should be undertaken by an experienced surgical team in a tertiary care facility.
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Affiliation(s)
- Jamie A Hymel
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Ark., USA
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Marcellin L, Ménard S, Lamau MC, Mignon A, Aubelle MS, Grangé G, Goffinet F. Conservative management of an advanced abdominal pregnancy at 22 weeks. AJP Rep 2014; 4:55-60. [PMID: 25032062 PMCID: PMC4078150 DOI: 10.1055/s-0034-1371749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/20/2014] [Indexed: 12/02/2022] Open
Abstract
Objective We report an uneventful conservative approach of an advanced abdominal pregnancy discovered at 22 weeks of gestation. Study Design This study is a case report. Results Attempting to extend gestation of an advanced abdominal pregnancy is not a common strategy and is widely questioned. According to the couple's request, the management consisted in continuous hospitalization, regular ultrasound scan, and antenatal corticosteroids. While the woman remained asymptomatic, surgery was planned at 32 weeks, leading to the birth of a preterm child without any long-term complications. Placenta was left in situ with a prophylactic embolization, and its resorption was monitored. Conclusion Depending on multidisciplinary cares and agreement of the parents, when late discovered, prolonging advanced abdominal pregnancy appears to be a reasonable option.
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Affiliation(s)
- Louis Marcellin
- Maternité Port-Royal, Groupe hospitalier Cochin, Broca, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France ; DHU Risques et Grossesse, Université Paris Descartes, Paris, France
| | - Sophie Ménard
- Maternité Port-Royal, Groupe hospitalier Cochin, Broca, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France ; DHU Risques et Grossesse, Université Paris Descartes, Paris, France
| | - Marie-Charlotte Lamau
- Maternité Port-Royal, Groupe hospitalier Cochin, Broca, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Mignon
- Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France ; Department of Anaesthesia and Critical Care Paris, Cochin University Hospital, Paris, France
| | - Marie Stephanie Aubelle
- DHU Risques et Grossesse, Université Paris Descartes, Paris, France ; Service de Médecine et Réanimation néonatales de Port-Royal, Groupe hospitalier Cochin, Broca, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gilles Grangé
- Maternité Port-Royal, Groupe hospitalier Cochin, Broca, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France ; DHU Risques et Grossesse, Université Paris Descartes, Paris, France
| | - François Goffinet
- Maternité Port-Royal, Groupe hospitalier Cochin, Broca, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France ; DHU Risques et Grossesse, Université Paris Descartes, Paris, France
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Fylstra DL. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol 2012; 206:289-99. [PMID: 22177188 DOI: 10.1016/j.ajog.2011.10.857] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 09/29/2011] [Accepted: 10/16/2011] [Indexed: 12/16/2022]
Abstract
Ectopic pregnancy is a very common diagnosis (2% of pregnancies), and implantation location varies. Although 97% of ectopics are implanted within the fallopian tube, associated with commonly recognized risk factors, ectopic implantation can occur in other pelvic and abdominal locations that may not have such predisposing risk factors. After an extensive review of the literature, along with the author's personal experience, implantation frequency, etiologic possibilities, and treatment options for each ectopic pregnancy location are presented. When ectopic pregnancy is diagnosed early, before rupture, regardless of location, conservative, fertility-sparing treatment options can be successful in terminating the pregnancy. Predisposing risk factors and treatment options can vary and can be ectopic-location specific.
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Affiliation(s)
- Donald L Fylstra
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
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Bang Ntamack JA, Ngou Mve Ngou JP, Sima Ole B, Sima Zue A, Mayi Tsonga S, Meye JF. [Abdominal pregnancy in Libreville from 1999 to 2009]. ACTA ACUST UNITED AC 2011; 41:83-7. [PMID: 21778024 DOI: 10.1016/j.jgyn.2011.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 06/08/2011] [Accepted: 06/17/2011] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Abdominal pregnancy (AP) is defined as the implantation and development of the fertilised egg in the cavity of peritoneum. It causes severe perinatal morbity and mortality. OBJECTIVE Underline the epidemiologic, diagnostic, therapeutic and prognostic aspects of the AP. METHODOLOGY Retrospective study conducted at Maternité Joséphine Bongo (maternity hospital) and at the Centre Hospitalier de Libreville (hospital centre) from January 1999 to December 2009 on 19 cases of abdominal pregnancies. RESULTS The frequency of AP in Libreville is one per 4447 deliveries (0.2 ‰) and one per 141 tubal ectopic pregnancies (0.7%). The mean age was 30.5 ± 7.2 years old and the mean parity 2.7 ± 1.7. The mean term of occurrence was 24.3 weeks of amenorrhoea (WA) with extremes at 14 and 39 WA. The diagnosis was made in the face of abdominal and pelvic pains in all the patients and an amenorrhoea in 11 cases (57%). It was confirmed by ultrasound scan in 14 cases (73.7%) and further to a laparotomy in five (26.3%) patients. We had two live births at 39 and 38 WA with respective birth weights of 2,380 and 2,550 g. Expulsion of the placenta was complete in seven (36.8%) cases. Five (26.3%) patients experienced hemorrhagic complications. CONCLUSION AP is a rare pathology. Its diagnosis beyond of the second quarter is difficult with an often-pejorative foetal forecast.
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Oneko O, Petru E, Masenga G, Ulrich D, Obure J, Zeck W. Management of the placenta in advanced abdominal pregnancies at an East african tertiary referral center. J Womens Health (Larchmt) 2011; 19:1369-75. [PMID: 20509789 DOI: 10.1089/jwh.2009.1704] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To review the diagnosis and treatment of 9 advanced abdominal pregnancies in a low-resource setting of a developing country, focusing on the management of the placenta. METHODS Abdominal pregnancies occurring between 1999 and 2007 were identified from hospital records in Tanzania. All patients were followed up for a median of 6 months after surgery (range 5-9 months). RESULTS At the time of diagnosis, pregnancies were between 20 and 42 weeks of gestation (median 27 weeks). All 9 mothers survived the abdominal pregnancy, and 7 fetuses died before delivery. The placenta was left completely in situ in 5 of the nine cases. CONCLUSIONS Abdominal pregnancy is often detected rather late in low-resource settings compared with higher-resource settings. We suggest that in the described low-resource setting where red blood cell transfusions are not always readily available, the placenta may be left in situ after removal of the fetus.
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Affiliation(s)
- Olola Oneko
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Tumaini University, Tanzania, East Africa
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Sherer DM, Dalloul M, Gorelick C, Kheyman M, Abdelmalek E, Zinn HL, Abulafia O. Unusual maternal vasculature in the placental periphery leading to the diagnosis of abdominal pregnancy at 25 weeks' gestation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:268-73. [PMID: 17436318 DOI: 10.1002/jcu.20375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Abdominal pregnancy is a rare condition in which the fetus and placenta are located within the peritoneal cavity. Sonographic findings include visualization of the fetus separate from the uterus, failure to visualize the uterine wall between the fetus and urinary bladder, close approximation of fetal parts to the maternal abdominal wall, eccentric position or abnormal fetal attitude, and visualization of extrauterine placental tissue. We present an unusual case in which mid-trimester transabdominal color Doppler sonographic findings depicted unusual maternal vasculature in the placental periphery leading to the diagnosis of abdominal pregnancy. Postpartum maternal angiography confirmed these vessels as abnormal maternal arterial perfusion of the extrauterine placenta emanating from the uterine arteries and inferior epigastric arteries. Systematic review of the literature confirms that this is the first report of such sonographic manifestations of an abdominal pregnancy.
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Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 445 Lenox Road, Box 24, Brooklyn, NY 11203, USA
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Faller E, Kauffmann E, Chevrière S, Heisert M, Ranjatoelina H, Boumahni B, Sitty-Amina AA, Barau G. [Full term abdominal pregnancy]. ACTA ACUST UNITED AC 2007; 35:732-5. [PMID: 17088777 DOI: 10.1016/s0368-2315(06)76472-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Abdominal pregnancy is a rare localization of ectopic pregnancy, more frequently observed in underdeveloped countries. We report a case of abdominal pregnancy carried to full term delivery, discovered at a time of a cesarean for low site of placenta attachment. Discovery of an abdominal pregnancy at the time of C-section seems exceptional with clinical and ulrasonographic surveillance of pregnancy. The objective of our article is to emphasize the importance of localizing the appendix at the first quarter echography and the utility of the endovaginal ulrasound.
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Affiliation(s)
- E Faller
- Service de Gynécologie Obstétrique, Groupe Hôspitalier Sud Réunion, BP 350, 97448 Saint-Pierre Cedex, La Réunion
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Roberts RV, Dickinson JE, Leung Y, Charles AK. Advanced abdominal pregnancy: still an occurrence in modern medicine. Aust N Z J Obstet Gynaecol 2005; 45:518-21. [PMID: 16401220 DOI: 10.1111/j.1479-828x.2005.00489.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In a world bewildered by spectacular advances in imaging technology, the early detection of an abdominal pregnancy should be a feasible objective. A case of an advanced abdominal pregnancy is presented. Although the pregnancy was the result of in vitro fertilisation technology, the diagnosis was not suspected until 35 weeks gestation. Both ultrasound and magnetic resonance imaging (MRI) were used to achieve a diagnosis prior to delivery. The placenta was left within the peritoneal cavity but removal was necessitated for maternal symptomatology 4 months postdelivery. This case illustrates that despite the almost ubiquitous usage of prenatal ultrasound, extrauterine pregnancies may not be detected in a timely manner unless attention to basic ultrasound techniques is followed.
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Affiliation(s)
- Rae V Roberts
- King Edward Memorial Hospital for Women, The University of Western Australia, Perth, Australia
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