Extrauterine pregnancy: a historical review(3)

Expectant management of advanced abdominal pregnancies: Is it justifiable?

OBJECTIVE

To evaluate the outcome of a case series of women with advanced abdominal pregnancies (AAP) who underwent expectant management.

STUDY DESIGN

A retrospective study that utilized prospective data of 46 women who were admitted for expectant management at a tertiary hospital in Durban, South Africa. All data was analyzed descriptively and presented in percentages.

RESULTS

The average period of expectant management was 27 days; thirty-three (72 %) of the 46 women were discharged from the hospital with live babies. There were 11 (24 %) neonatal deaths and two cases of stillbirths. There were no maternal deaths and morbidity was minimal.

CONCLUSION

When diagnosed after the 24th week of gestation, an option is expectant management which includes careful patient selection, prolonged hospitalization, and close antenatal fetal and maternal surveillance to achieve fetal viability. Management by experienced clinicians and a multidisciplinary team in a tertiary institution is recommended. Informed consent needs to take into consideration the risks with interventional laparotomy, social separation from family and friends, and the guarded perinatal outcome.

Advanced extrauterine pregnancy: diagnostic and therapeutic challenges

OBJECTIVE

The objective of the study was to identify women with advanced extrauterine pregnancy, specifically assessing the problems encountered with their diagnosis and management, preoperative evaluation, and surgical removal.

STUDY DESIGN

This was a case series including women diagnosed with an extrauterine pregnancy of 18 weeks' gestation or greater at our institution from 1980 to 2005.

RESULTS

We identified 10 women with advanced extrauterine pregnancies during the study period. Diagnosis was not optimal, and only 6 were discovered preoperatively. Despite the fact that only 3 of 10 women met diagnostic criteria for an abdominal pregnancy, surgical dissection was universally difficult, and hemorrhage was common with 9 of 10 patients requiring blood transfusions. In 2 women, the placenta was left in situ, and both developed serious complications. All 5 viable fetuses survived, but their courses were long and complicated.

CONCLUSION

Irrespective of placental implantation site, an advanced extrauterine pregnancy is a serious condition. The currently accepted definition of abdominal pregnancy is too exclusive.

Role of sonography in the diagnosis of ectopic pregnancy

This review addresses the use of sonography in the evaluation of patients suspected of having ectopic pregnancy. The use of transvaginal and transabdominal sonography and the role of Doppler imaging in the early diagnosis of ectopic pregnancy are discussed. Various sonographic findings and pitfalls of ectopic pregnancy are analyzed, with emphasis on their diagnostic efficacies.