Term extrauterine pregnancy in a Nigerian mother: a complication of uterine dehiscence

Combined uterine injury and high rectal perforation complicating abdominal ectopic pregnancy: A case report

INTRODUCTION AND IMPORTANCE

Abdominal pregnancy is a rare and potentially fatal variant of ectopic pregnancy, presenting unique clinical challenges. This report discusses an unusual case of abdominal pregnancy associated with uterine and high rectal perforations, complications that are rarely reported in clinical practice.

CASE PRESENTATION

We report a case involving a 31-year-old woman from a rural area, with a psychiatric history, presenting severe abdominal pain, vomiting, and constipation. Initial investigations revealed a hemopneumoperitoneum and a fetal skeleton in the pelvic area by CT, leading to a diagnosis of abdominal pregnancy. Surgical findings included a nonviable fetus, approximately 5 months gestational age, and perforations in both the rectum and the posterior uterine wall.

CLINICAL DISCUSSION

The patient underwent extensive surgery, including placental dissection, anterior rectal resection, Hartmann's colostomy, hysterorrhaphy, and drainage of the peritoneal cavity. The complexity of managing abdominal pregnancy, especially with additional complications such as organ perforations, poses significant surgical challenges. This case emphasizes the need to consider abdominal pregnancy in differential diagnoses of abdominal pain in women, due to the risk of misdiagnosis and complex surgical requirements.

CONCLUSION

This case highlights the critical importance of prompt diagnosis and comprehensive care in managing rare and life-threatening presentations of abdominal pregnancy. It underscores the need to increase awareness among clinicians for timely intervention and provides information on the complexities of surgical management in cases with additional organ perforations.

Experience of Secondary Abdominal Pregnancy Reported at a Rural Tertiary Care Center of Western India: A Case Series

Abdominal pregnancy remains a rare entity among ectopic pregnancies overall; however, it carries the highest risk of mortality and morbidity for the mother and the fetus. Prompt diagnosis and early intervention remain the main modality of treatment to prevent catastrophic complications because of abdominal pregnancy. However, many barriers exist, leading to delayed diagnosis and management. We present three cases of secondary abdominal pregnancy with different outcomes over three years from 2018 to 2021. The clinical presentation, evaluation, management plan, and outcomes of the cases are discussed separately.

Term Abdominal Pregnancy with Live Baby: Case Report from Hiwot Fana Specialized University Hospital, Eastern Ethiopia

Purpose

To present a rare case of term abdominal pregnancy with live baby.

Observation

A 30-year-old gravida VI para V, all alive, woman who did not remember her last menstrual period but was stated amenorrheic for 9 months visited Hiwot Fana Specialized University Hospital (HFSUH) with abdominal pain of two weeks duration. The woman was diagnosed with a term abdominal pregnancy and underwent a laparotomy. The outcome of treatment was a 3200 gm healthy male baby and a total abdominal hysterectomy was done.

Conclusion and Importance

Term abdominal pregnancy is an extremely rare type of ectopic pregnancy that can cause diagnostic challenges and leads to life threatening conditions both before and after diagnosis because of the rupture of major blood vessels.

Successful Management of Abdominal Pregnancy: Two Case Reports

Abdominal pregnancy is a rare, life-threatening condition defined as pregnancy in the peritoneal cavity exclusive of tubal, ovarian, or intraligamentary locations. It can be primarily located in the peritoneal cavity or secondary to a ruptured ectopic pregnancy or tubal abortion. We present two cases of abdominal pregnancy, one primary and another secondary, both diagnosed and successfully managed in our institution. The first patient, a para 2 at 14 weeks gestation, presented with abdominal pain, distension, and dizziness, which had started four days prior. The initial radiological scan reported an intrauterine pregnancy with ascites, but a bedside ultrasound revealed an empty uterus and a viable pregnancy located in the Pouch of Douglas (POD). This was a secondary abdominal pregnancy managed successfully by laparotomy. The second patient, a para 3 + 4 miscarriages with seven weeks amenorrhea was admitted with an initial diagnosis of pregnancy of unknown location. She had a beta human chorionic gonadotropin level of 14 444 mIU/mL. Diagnostic laparoscopy revealed a hemoperitoneum, bulky uterus, normal looking right and left adnexa, and a dense irregular bleeding tissue of around 3 × 4 cm firmly attached to the POD. The histopathology report of the tissue retrieved from the POD confirmed products of conception. This case report supports the importance of awareness and high clinical suspicion for such a life-threatening condition to avoid maternal morbidity and mortality. To the best of our knowledge, no previous cases of abdominal pregnancy have been reported in the UAE to date.

Evaluating a magnetic resonance imaging of the third-trimester abdominal pregnancy: What the radiologist needs to know

INTRODUCTION

A 33-week abdominal pregnancy is an extremely rare type of ectopic pregnancy that is potentially life-threatening for the mother and fetus. Reports of using magnetic resonance imaging (MRI) in the third-trimester abdominal pregnancy are very few.

PATIENT CONCERNS

A 24-year-old woman (gravida 2, para 1, living 0) at 33 weeks' gestation presented to local hospital complaining of vaginal bleeding for 2 months and lower abdominal pain for 2 days. Then, the woman was transferred to our hospital for suspected abdominal pregnancy, which was confirmed at our hospital on ultrasonography and further evaluated in detail on MRI.

DIAGNOSES

The woman was diagnosed as having abdominal pregnancy.

INTERVENTIONS

The woman was managed surgically, the unviable fetus was removed, and the placenta was left in situ. Then, the woman was managed with fluids, blood transfusion, antibiotics, and systemic methotrexate after surgery.

OUTCOMES

At 42 days postoperatively, the affected woman was discharged in a good condition.

CONCLUSIONS

By using MRI, we can accurately diagnose an abdominal pregnancy. MRI provides more details than ultrasonography, and explains the possible mechanism of abdominal pregnancy. We advocate using MRI to help surgical planning and improve outcome in cases of abdominal pregnancy.

Term abdominal pregnancy: a case report

INTRODUCTION

Abdominal pregnancy is a rare form of ectopic pregnancy with very high maternal and fetal morbidity and mortality. A high index of suspicion is crucial for prompt diagnosis and management especially in low-resource countries.

CASE PRESENTATION

A 32-year-old gravida III para II Amhara woman presented with shortness of breath and progressive abdominal distension and pain. An emergency laparotomy was performed with the impression of abdominal pregnancy. Intraoperatively, the fetus was seen in an intact amniotic sac in her abdomen, her uterus was ruptured at the fundus and the placenta was extensively adhered to the edge of the ruptured site. The patient and neonate progressed well and were discharged.

CONCLUSIONS

Term abdominal pregnancy is an extremely rare diagnosis and requires a high index of suspicion. The life-threatening complication is bleeding from the detached placental site. A thorough examination of the newborn is important to rule out congenital anomalies.