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: 4] [Impact Index Per Article: 1.0] [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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