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Kang OJ, Koh JH, Yoo JE, Park SY, Park JI, Yang S, Lee SH, Lee SJ, Ahn JW, Roh HJ, Kim JS. Ruptured Hemorrhagic Ectopic Pregnancy Implanted in the Diaphragm: A Rare Case Report and Brief Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11122342. [PMID: 34943579 PMCID: PMC8699918 DOI: 10.3390/diagnostics11122342] [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: 11/13/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
The mortality and morbidity rates of non-tubal ectopic pregnancies with abdominal hemorrhaging are 7-8 times higher than those of tubal pregnancies. Diaphragmatic pregnancy is a rare non-tubal ectopic form, causing acute abdominal hemoperitoneum. Here, we present a case of a primary diaphragmatic ectopic pregnancy with hemorrhage that was immediately diagnosed and successfully managed with laparoscopic surgery. Rapid and accurate diagnosis using appropriate imaging modalities is critical for improving the prognosis of a child-bearing woman with an abdominal pregnancy.
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Affiliation(s)
- Ok Ju Kang
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea;
| | - Ji Hye Koh
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - Ji Eun Yoo
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - So Yeon Park
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - Jeong-Ik Park
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.-I.P.); (S.Y.)
| | - Songsoo Yang
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.-I.P.); (S.Y.)
| | - Sang-Hun Lee
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - Soo-Jeong Lee
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - Jun-Woo Ahn
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - Hyun-Jin Roh
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
| | - Jeong Sook Kim
- Department of Obstetrics and Gynecology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea; (J.H.K.); (J.E.Y.); (S.Y.P.); (S.-H.L.); (S.-J.L.); (J.-W.A.); (H.-J.R.)
- Correspondence:
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2
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Diagnostic Challenges of an Abdominal Pregnancy in the Second Trimester. Case Rep Obstet Gynecol 2021; 2021:7887213. [PMID: 34395003 PMCID: PMC8355995 DOI: 10.1155/2021/7887213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/24/2021] [Indexed: 11/18/2022] Open
Abstract
Abdominal pregnancies are a rare form of ectopic pregnancy, which presents a significant risk of maternal morbidity and mortality. We describe an unusual case of a late diagnosis of an abdominal pregnancy in the second trimester, which due to diagnostic challenges, was not detected on 1st trimester and subsequent antenatal ultrasound scans (USS). The abdominal pregnancy was later diagnosed at the repeat anomaly scan and confirmed with a pelvic MRI. This case of abdominal pregnancy is unique when compared to other reported cases, as the fetus was initially enclosed within the amniotic sac with normal liquor volume. Both transvaginal and transabdominal scans appeared to demonstrate an intrauterine pregnancy. The diagnosis of abdominal pregnancy was only made possible following rupture of the amniotic sac, leading to anhydramnios, which resulted in the repositioning of the fetus to the upper maternal abdomen. This case represents the challenges faced by obstetricians in diagnosing, managing, and counselling a woman when faced with an abdominal pregnancy.
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Cagino K, Pereira N, Fields JC, Fenster TB. Laparoscopic management of a primary posterior cul-de-sac abdominal ectopic pregnancy. Fertil Steril 2021; 116:605-607. [PMID: 33892956 DOI: 10.1016/j.fertnstert.2021.03.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report a case of laparoscopic management of a primary posterior cul-de-sac abdominal ectopic pregnancy (AEP). DESIGN Video article. SETTING Academic medical center. PATIENT(S) A 40-year-old G5P3013 woman at approximately 7 weeks of pregnancy was referred to our emergency department because of abnormally rising β-human chorionic gonadotropin levels. Transvaginal ultrasonography revealed a cystic structure measuring 2.8 × 1.6 ×1.9 cm in the posterior cul-de-sac distinct from the cervix. The mass was noted to have peripheral hypervascularity and a thickened wall. A moderate amount of complex free fluid was noted adjacent to the mass. The patient's baseline β-human chorionic gonadotropin level and hematocrit were 6,810.7 mIU/mL and 42.4%, respectively. INTERVENTION(S) Laparoscopy for suspected AEP. MAIN OUTCOME MEASURE(S) Laparoscopic excision of a primary AEP. RESULT(S) Diagnostic laparoscopy revealed a normal uterus, normal right ovary, normal left ovary with a corpus luteal cyst, and normal bilateral fallopian tubes without dilatation or hemorrhage. The AEP was noted in the right posterior cul-de-sac and was excised from the underlying peritoneum. The left lateral aspect of the AEP extended into the posterior vaginal wall. The patient was admitted for overnight observation, and her postoperative hematocrit was 35.1%. CONCLUSION(S) AEPs are extremely rare and account for 1% of all ectopic pregnancies. Approximately 90% of AEPs require surgical management. Historically, AEPs were treated with laparotomy because of the high risk of hemorrhage and hemodynamic instability. However, as exemplified by the current case, laparoscopy is a safe and feasible option for surgical management of AEPs.
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Affiliation(s)
- Kristen Cagino
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Nigel Pereira
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York
| | - Jessica C Fields
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Tamatha B Fenster
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York.
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4
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Gurjar R. Full-Term Live Secondary Abdominal Pregnancy: A Rare Case Report. J Obstet Gynaecol India 2019; 69:36-39. [PMID: 30956489 DOI: 10.1007/s13224-018-1156-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/11/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Rajkumar Gurjar
- Department of Obstetrics and Gynaecology, RNT Medical College Udaipur, Udaipur, India
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5
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Abstract
A 26-year-old unmarried female with a history of acute abdominal pain and bleeding per vagina was brought unresponsive to the hospital. She was in shock on arrival and could not be resuscitated. Death was registered as a medico-legal case. Further investigation by the police revealed that she had amenorrhoea for eight weeks and had tested positive for pregnancy. She had consumed abortion pills purchased from a local pharmacist without consulting a doctor and had developed acute abdominal pain after 48 h. Autopsy revealed a ruptured ectopic pregnancy (tubal type).
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Affiliation(s)
- S H Jayanth
- Department of Forensic Medicine, M.S. Ramaiah Medical College, Bangalore, India
| | - Girish Chandra
- Department of Forensic Medicine, M.S. Ramaiah Medical College, Bangalore, India
| | - S Praveen
- Department of Forensic Medicine, M.S. Ramaiah Medical College, Bangalore, India
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Prabhu M, Eckert LO, Belfort M, Babarinsa I, Ananth CV, Silver RM, Stringer E, Meller L, King J, Hayman R, Kochhar S, Riley L. Antenatal bleeding: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2017; 35:6529-6537. [PMID: 29150058 PMCID: PMC5710989 DOI: 10.1016/j.vaccine.2017.01.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/13/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Malavika Prabhu
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.
| | - Linda O Eckert
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Michael Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA; Department of Obstetrics and Gynecology, Texas Children's Hospital, Houston, TX, USA
| | - Isaac Babarinsa
- Sidra Medical and Research Center/Weill Cornell Medicine-Qatar/Women's Hospital, Qatar
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Physicians, Columbia University, New York, NY, USA; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth Stringer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, NC, USA
| | - Lee Meller
- Gloucestershire Hospitals NHS Foundation Trust, UK
| | - Jay King
- SanofiPasteur, Swiftwater, PA, USA
| | - Richard Hayman
- Department of Obstetrics and Gynaecology, Gloucestershire Hospital, Gloucester, UK
| | - Sonali Kochhar
- Global Healthcare Consulting, India; Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Laura Riley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
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7
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Alalade AO, Smith FJE, Kendall CE, Odejinmi F. Evidence-based management of non-tubal ectopic pregnancies. J OBSTET GYNAECOL 2017. [PMID: 28631522 DOI: 10.1080/01443615.2017.1323852] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent advances in ultrasonography and the use of other modalities including magnetic resonance imaging scans have led to the early and more accurate diagnosis of non-tubal ectopic pregnancies (NTE). As a result, the management of these pregnancies has evolved. This article addresses the management options currently available for NTE. While surgical management remains the mainstay of treatment for ovarian, abdominal and cornual ectopics, there is growing evidence that some of these can be managed medically. Many authors have utilised a combination of medical and surgical approaches in the management of cervical and caesarean section (CS) scar ectopic pregnancies with good outcome. The availability of dedicated early pregnancy units has further improved diagnosis and more importantly the follow-up care for these patients. The rarity of cases and the difficulty of ethically organising randomised trials for NTE remain a problem in formulating consistent pathways for optimum management of women with NTE.
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Affiliation(s)
- Aderemi Olaoluwa Alalade
- a Department of Obstetrics and Gynaecology , Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board , Wrexham , UK
| | - Fredrick John Ennis Smith
- b Cochrane Medical Education Centre, Institute of Medical Education, Cardiff University School of Medicine, Cardiff University , Cardiff , UK
| | - Charlotte Emma Kendall
- b Cochrane Medical Education Centre, Institute of Medical Education, Cardiff University School of Medicine, Cardiff University , Cardiff , UK
| | - Funlayo Odejinmi
- c Department of Obstetrics and Gynaecology, Barts Health NHS Trust , Whipps Cross University Hospital , London , England
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8
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Ultrasound-Guided Percutaneous Management of Splenic Ectopic Pregnancy. J Minim Invasive Gynecol 2016; 23:997-1002. [DOI: 10.1016/j.jmig.2016.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 11/18/2022]
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9
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Abstract
Abdominal pregnancy is a rare but life-threatening condition. The preoperative diagnosis may be difficult. When there is a suspicion of abdominal pregnancy and ultrasonographic findings are equivocal or inconclusive, MR imaging should be performed. We report a case of an abdominal pregnancy of 28 weeks' gestation diagnosed by MR.
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10
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Nassali MN, Benti TM, Bandani-Ntsabele M, Musinguzi E. A case report of an asymptomatic late term abdominal pregnancy with a live birth at 41 weeks of gestation. BMC Res Notes 2016; 9:31. [PMID: 26785887 PMCID: PMC4717624 DOI: 10.1186/s13104-016-1844-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 01/08/2016] [Indexed: 11/11/2022] Open
Abstract
Background Despite advances in diagnostic imaging and focused antenatal care, cases of undiagnosed abdominal pregnancies at term are still reported in obstetric practice. It is atypical and very rare for a patient to be asymptomatic late in pregnancy and for the pregnancy to result in a live birth with no evidence of intrauterine growth restriction despite the unfavourable implantation site. This late term asymptomatic presentation despite routine antenatal care demonstrates a diagnostic challenge. Case presentation We report a case of a 26 year old Primigravida with an asymptomatic and undiagnosed abdominal pregnancy carried beyond 41 weeks of gestation espite routine antenatal care and serial ultrasound reports. She presented for a routine antenatal care visit at 41 weeks of gestation. Induction of labour was initiated due to the late term gestation but was unsuccessful. At this point the fetus developed severe tachycardia and CTG confirmed persistent non-reassuring foetal heart rate patterns. The mother was then prepared for an emergency caesarean delivery. Abdominal pregnancy was only diagnosed at laparotomy where a term male baby weighing 3108 g was delivered with an Apgar Score of 7 and 8 at 1 and 5 min respectively. The placenta which was implanted into the omentum, ileal mesentery and extending to the pouch of Douglas was removed following active bleeding from its detached margins. She was transfused with two units of blood and four units of fresh frozen plasma. Postoperative morbidity was minimal with transient paralytic ileus on the second post-operative day. Her recovery was otherwise uneventful and she was discharged on the seventh post-operative day in good condition. The neonate developed meconium aspiration syndrome and passed away on the 2nd day of life despite having undergone standard care. A post-mortem examination was not performed because the family did not consent to the procedure. Follow up of the mother at 2, 6 weeks and 6 months postpartum was uneventful. Conclusions This atypical presentation of an asymptomatic abdominal pregnancy carried tolate term and only diagnosed at laparotomy despite routine antenatal care demonstrates a significant lapse in diagnosis. Clinicians and radiologists must always bear this possibility in mind during routine client evaluation. Skills training in Obstetric ultrasound and in the clinical assessment of obstetric patients should emphasize features suggestive of abdominal pregnancy. This will improve diagnosis, ensure appropriate management and minimise complications. Immediate termination of pregnancy can be offered if the diagnosis is made before 20 weeks of gestation. Patients diagnosed with advanced abdominal pregnancies and are stable can be monitored under close surveillance and delivered at 34 weeks of gestation after lung maturity is achieved. Although removal of the placenta carries a higher risk of haemorrhage, a partially detached placenta can be delivered with minimal morbidity and a good maternal outcome. Given the documented low survival rates of neonates in such cases, neonatal units must be adequately equipped and staffed to support them. Post-mortem examination is important to confirm cause of death and exclude other complications and congenital anomalies. Communities need to be educated about the importance of this procedure.
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Affiliation(s)
- Mercy Nkuba Nassali
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Private Bag 00713, Gaborone, Botswana.
| | - Tadele Melese Benti
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Private Bag 00713, Gaborone, Botswana.
| | - Moreri Bandani-Ntsabele
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Private Bag 00713, Gaborone, Botswana.
| | - Elly Musinguzi
- Department of Obstetrics and Gynaecology, Princess Marina Hospital, P.O. Box 258, Gaborone, Botswana.
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11
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Mitra KR, Ratnaparkhi CR, Gedam BS, Tayade KA. An unusual case of retained abdominal pregnancy for 36 years in a postmenopausal woman. Int J Appl Basic Med Res 2015; 5:208-10. [PMID: 26539374 PMCID: PMC4606584 DOI: 10.4103/2229-516x.165374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Abdominal pregnancy is a rare form of ectopic pregnancy which occurs due to ruptured uterine or tubal pregnancy into the abdomen. Fetal loss is a common complication of these pregnancies and patient presents with acute abdominal pain which is a surgical emergency. Another rare but established complication of this ectopic pregnancy is fetal demise with the dead fetus being retained in the abdomen. It gets macerated and mummified over a period of time and is mostly detected incidentally during imaging. Radiological imaging has hallmark appearances of such a macerated fetus showing multiple fetal parts embedded in a calcified sac termed as lithopedion or stone baby. We report a unique case of retained abdominal pregnancy for 36 years in a 60-year-old postmenopausal female presented with abdominal pain and difficulty in micturition. Computed tomography showed multiple fetal bones in the abdomen surrounded by a membrane which was surprisingly not calcified.
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Affiliation(s)
- Kajal Ramendranath Mitra
- Department of Radiodiagnosis, Lata Mangeshkar Hospital, Digdoh Hills, Nagpur, Maharashtra, India
| | | | - Bapuji Shrawan Gedam
- Department of Surgery, Lata Mangeshkar Hospital, Digdoh Hills, Nagpur, Maharashtra, India
| | - Kushal Ashok Tayade
- Department of Radiodiagnosis, Lata Mangeshkar Hospital, Digdoh Hills, Nagpur, Maharashtra, India
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12
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An unusual cause of intra-abdominal calcification: A lithopedion. Eur J Radiol Open 2014; 1:60-3. [PMID: 26937428 PMCID: PMC4750627 DOI: 10.1016/j.ejro.2014.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/30/2014] [Indexed: 11/22/2022] Open
Abstract
We report a case of a 77-year-old female who was admitted to the emergency department complaining of diffuse abdominal pain for five days, associated with nausea, vomiting and constipation. Physical examination disclosed a large incarcerated umbilical hernia, which was readily apparent on supine abdominal plain films. These also showed a calcified heterogeneous mass in the mid-abdominal region, which was further characterized by CT as a lithopedion (calcified ectopic pregnancy). This is one of the few cases studied on a MDCT equipment, and it clearly enhances the post-processing abilities of this imaging method which allows diagnostic high-quality MIP images. Lithopedion is a rare entity, with less than 300 cases previously described in the medical literature. However, many reported cases corresponded to cases of skeletonization or collections of fetal bone fragments discovered encysted in the pelvic region at surgery or autopsy. It is thus estimated that true lithopedion is a much rarer entity. The diagnosis may be reached by a suggestive clinical history and a palpable mass on physical examination, while the value of modern cross-sectional techniques is still virtually unknown. Ultrasonography may depict an empty uterine cavity and a calcified abdominal mass of non-specific characteristics, and computed tomography or magnetic resonance imaging are able to reach a conclusive diagnosis and may additionally define the involvement of adjacent structures. The differential diagnosis includes other calcified pathologic situations, including ovarian tumors, uterine fibroids, urinary tract neoplasms, inflammatory masses or epiploic calcifications.
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13
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A 26-year-old retained demised abdominal pregnancy presenting with umbilical fistula. Case Rep Obstet Gynecol 2014; 2014:932525. [PMID: 24639908 PMCID: PMC3930028 DOI: 10.1155/2014/932525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 12/23/2013] [Indexed: 11/17/2022] Open
Abstract
This is a report on a 72-year-old postmenopausal woman who presented with passage of fetal bones through an umbilical fistula. She was diagnosed as a case of demised abdominal pregnancy, which had been retained for 26 years. She subsequently had exploratory laparotomy, evacuation of the abdominal pregnancy, hysterectomy, and bowel resection. The patient's condition remained unstable throughout the postoperative period and she died from septicemia on the eleventh day.
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14
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Medhi R, Nath B, Mallick MP. Lithopedion diagnosed during infertility workup: a case report. SPRINGERPLUS 2014; 3:151. [PMID: 24741475 PMCID: PMC3979976 DOI: 10.1186/2193-1801-3-151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 11/18/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Robin Medhi
- Department of obstetrics and gynaecology, Silchar Medical College and Hospital, Silchar, Assam 788014 India
| | - Banashree Nath
- Department of obstetrics and gynaecology, Silchar Medical College and Hospital, Silchar, Assam 788014 India
| | - Mangal Prasad Mallick
- Department of obstetrics and gynaecology, Ramakrishna Mission Seva Pratisthan, 99 Sarat Bose Road, Kolkata, West Bengal 700026 India
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15
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Kumar SS, Murthy AS, Kumar DMS, Navukarasu RT. Laparoscopic removal of lithopaedion. Indian J Surg 2014; 75:38-40. [PMID: 24426507 DOI: 10.1007/s12262-011-0313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 02/21/2011] [Indexed: 11/26/2022] Open
Abstract
Lithopaedion means a calcified Dead foetus and it is usually extrauterine. We report a case of 32 year old female who presented to us with right iliac fossa mass. On diagnostic laparoscopy, it was found to be Lithopaedion and the same was removed in toto through laparoscopic approach.
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Affiliation(s)
- S Sujith Kumar
- Department of General Surgery, Vinayaga Missions Medical College & Hospital, Karaikal, 609602 Pondicherry, UT India
| | - A Sambanda Murthy
- Department of General Surgery, Vinayaga Missions Medical College & Hospital, Karaikal, 609602 Pondicherry, UT India
| | - D Muthiah Selva Kumar
- Department of General Surgery, Vinayaga Missions Medical College & Hospital, Karaikal, 609602 Pondicherry, UT India
| | - R Thiru Navukarasu
- Department of General Surgery, Vinayaga Missions Medical College & Hospital, Karaikal, 609602 Pondicherry, UT India
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16
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Maiorana A, Incandela D, Giambanco L, Alio W, Alio L. Omental pregnancy: case report and review of literature. Pan Afr Med J 2014; 19:244. [PMID: 25852787 PMCID: PMC4382054 DOI: 10.11604/pamj.2014.19.244.3661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 05/07/2014] [Indexed: 11/11/2022] Open
Abstract
Pregnancy, the implantation of a fertilized ovum outside the endometrial cavity, occurs in 1.5%-2% of pregnancies. It is one of the major causes (about 6%) of maternal death during the first trimester of pregnancy. The remaining 5% implant in the ovary, peritoneal cavity, within the cervix, and the omental pregnancy is the least common form of abdominal pregnancies. A review of the literature on Medline for the period 1958-2012 reported only 16 cases of omental pregnancy. Here we report a case of primary omental pregnancy in a nulliparous woman. A 24 year-old woman gravid 1, para 0, with lower abdominal pain. Her last menstrual period occurred 8 weeks before the visit. The physical examination revealed abdominal tenderness in the lower quadrants, she was not bleeding. Transvaginal ultrasound showed: a free anechoic/hypoechoic area of 30 x 57 mm in the pouch of Douglas and the endometrium was homogeneus with a thickness of 12 mm and no evidence of gestational sac in the uterine cavity. Laboratory data revealed a normal cell blood count and beta hcg levels of 8047 IU / L. Because of continuing abdominal pain and a diagnosis of ectopic pregnancy a diagnostic laparoscopy was performed, which showed hemoperitoneum. Further inspection of abdominal cavity revealed a bloody lesion that was tenaciously adherent to the omentum, using non traumatic laparoscopic forceps and bipolar scissors we carefully removed a friable mass of about 30 mm from the omental attachments. Histological examination showed the presence of blood clot material mixed with trophoblastic tissue. Ultrasound evaluation and and hCG assessment are important to determine the extrauterine location of the ectopic pregnancy but the early diagnosis of abdominal pregnancy requires also a laparoscopic evaluation and, as our case has highlighted, thorough abdominal exploration especially in the absence of adnexal findings when ectopic pregnancy is highly suspected. Early diagnosis of omental pregnancy is difficult but essential to reduce the high mortality risk for the mother.
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Affiliation(s)
- Antonio Maiorana
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
| | - Domenico Incandela
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
| | - Laura Giambanco
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
| | - Walter Alio
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
| | - Luigi Alio
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
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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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Shafi SM, Malla MA, Salaam PA, Kirmani OS. Abdominal pregnancy as a cause of hemoperitoneum. J Emerg Trauma Shock 2011; 2:196-8. [PMID: 20009311 PMCID: PMC2776369 DOI: 10.4103/0974-2700.55342] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The coexistence of intrauterine and extrauterine pregnancy, the heterotopic pregnancy, is a rare obstetric phenomenon. The preoperative diagnosis of this condition is very difficult; leading to a higher maternal morbidity and fetal loss. We experienced a case of intrauterine pregnancy and ruptured abdominal pregnancy implanted on the illeocaecal region in a 26-year-old primiparous woman. She was clinically misdiagnosed as a case of ruptured ectopic pregnancy, but ultrasonography showed it to be a case of heterotopic pregnancy. Subsequently, the patient was subjected to laparotomy and the ruptured abdominal pregnancy was evacuated. She continued with the intrauterine pregnancy till term and delivered a healthy female baby. Although this condition is unusual, any general surgeon in the emergency department must be aware of this complication and its management, which is often initially misdiagnosed.
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Koo HS, Bae JY, Kang IS, Koong MK, Kim HO, Cha SH, Choi MH, Kim JY, Yang KM. Laparoscopic management of early primary peritoneal pregnancy: a case report. Clin Exp Reprod Med 2011; 38:109-14. [PMID: 22384428 PMCID: PMC3283056 DOI: 10.5653/cerm.2011.38.2.109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 05/31/2011] [Accepted: 06/03/2011] [Indexed: 11/16/2022] Open
Abstract
Peritoneal pregnancy is an implantation in the peritoneal cavity exclusive of tubal, ovarian, or intra-ligamentary implantations. This is a rare obstetric complication with high maternal mortality and even higher perinatal mortality, and secondary type was most common. Risk factors for peritoneal pregnancy are previous history of extrauterine pregnancy or tubal surgery pelvic post-inflammatory status or presence of an intra-uterine device. As it is a life-threatening condition, expectant management carries a risk of sudden life-threatening intra-abdominal bleeding and a generally poor fetal prognosis. So, when it is recognized, immediate termination of pregnancy is usually recommended. Early diagnosis of peritoneal pregnancy is difficult, but is important by their life threatening progress course to patients. Recently, we experienced primary peritoneal pregnancy which meets both the original and modified criteria. In this paper, we reported the case of early diagnosed and successfully treated peritoneal pregnancy despite of their diagnosis was incidentally.
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Affiliation(s)
- Hwa Seon Koo
- Department of Obstetrics & Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
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Seckin B, Turkcapar FA, Tarhan I, Yalcin HR. Advanced intraligamentary pregnancy resulting in a live birth. J OBSTET GYNAECOL 2011; 31:260-1. [DOI: 10.3109/01443615.2011.553691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Secondary abdominal pregnancy and its associated diagnostic and operative dilemma: three case reports. J Med Case Rep 2009; 3:7382. [PMID: 19830195 PMCID: PMC2737786 DOI: 10.4076/1752-1947-3-7382] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 01/27/2009] [Indexed: 11/17/2022] Open
Abstract
Introduction Abdominal pregnancy is extremely rare and has historically been defined as an implantation in the peritoneal cavity, exclusive of tubal, ovarian or intraligamentary pregnancy. Case presentations Three cases are reported. All came from a lower middle-income group and all of them were subjected to surgery. The first patient was a 30-year-old woman, who was pregnant for the fourth time, who presented at 16 weeks with an abdominal pregnancy. She was admitted with constant abdominal pain and retention of urine. She was hemodynamically stable and was administered a pre-operative intramuscular injection of methotrexate. During laparotomy she had only minor blood loss, the major part of the placenta was removed easily and she did not require any blood transfusion. Serum beta human chorionic gonadotrophin values and ultrasound follow-up revealed a normal study four weeks after surgery. The second patient was a 26-year-old woman, pregnant for the third time, admitted at 14 weeks with an abdominal pregnancy with hemoperitoneum, and the third patient was a 24-year-old woman, pregnant for the first time, who presented at 36 weeks gestation. She was only diagnosed as having an abdominal pregnancy during surgery, experienced excessive blood loss and required a longer hospital stay. Conclusions We hypothesize that treatment with pre-operative systemic methotrexate with subsequent laparotomy for removal of the fetus and placenta may minimize potential blood loss, and would be a reasonable approach in the care of a patient with an abdominal pregnancy with placental implantation to the abdominal viscera and blood vessels. This treatment option should be considered in the management of this potentially life-threatening condition. During surgery, if the placenta is attached to vital organs it should be left behind. Early diagnosis can help in reducing associated maternal morbidity and mortality.
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Abstract
BACKGROUND Abdominal pregnancy is a rare, life-threatening variant of ectopic pregnancy, and thus its diagnosis and management remain controversial. CASE A multigravida was admitted for complaints of abdominal swelling that had been occurring for 2 years and symptoms of pregnancy in the 3 months before admission. Radiologic studies revealed a live intraabdominal pregnancy at 15 weeks of gestation with a concurrent lithopedion of advanced gestation. The patient underwent laparotomy, removing both fetuses; the placenta was left in situ. She was discharged 1 week later in good condition. CONCLUSION The case of a concurrent lithopedion of advanced gestation and a live intraabdominal ectopic pregnancy was successfully managed.
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24
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Acheson N, Taylor WG, Hiadzi E, Pillingk D, Hanretty P, Whittle MJ. Advanced abdominal pregnancy: Difficulties in diagnosis. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619609020711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Milicevic S, Vilendecic Z, Dokic M, Radunovic N, Stamenovic S, Stankovic A, Ljubic A. Heterotopic pregnancy: Still a diagnostic puzzle. J OBSTET GYNAECOL 2009; 28:458-9. [DOI: 10.1080/01443610802164839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Bertrand G, Le Ray C, Simard-Emond L, Dubois J, Leduc L. Imaging in the management of abdominal pregnancy: a case report and review of the literature. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:57-62. [PMID: 19208285 DOI: 10.1016/s1701-2163(16)34055-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Abdominal pregnancy is a rare condition that is potentially life-threatening for the mother. CASE A 29-year-old woman presented with abdominal pain at 17 weeks of pregnancy. An ultrasound scan demonstrated an active abdominal pregnancy. MRI was used for placental localization. After discussion with the woman, it was decided to proceed to termination of the pregnancy. A pelvic angiogram was performed to localize placental vascularization. Both uterine arteries were embolized. Catheterization of the ovarian arteries identified that the right ovarian artery was one of the main vessels supplying the placenta. Selective embolization was performed. Laparotomy was then performed with removal of the fetus, but the placenta was left in place. Use of methotrexate was not required in the postoperative period. The patient was discharged on the seventh postoperative day. Serum BhCG became negative within one month. CONCLUSION In the management of abdominal pregnancy, the use of imaging and radio-interventional techniques is critical in minimizing surgical and post-surgical interventions.
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Affiliation(s)
- Geneviève Bertrand
- Department of Obstetrics and Gynecology, CHU Sainte-Justine, Montreal QC
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Gomez E, Vergara L, Weber C, Wong AE, Sepulveda W. Successful expectant management of an abdominal pregnancy diagnosed at 14 weeks. J Matern Fetal Neonatal Med 2009; 21:917-20. [PMID: 19065464 DOI: 10.1080/14767050802353556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A rare case of abdominal pregnancy, diagnosed by ultrasound at 14 weeks' gestation, was managed conservatively resulting in the delivery of a viable infant at 32 weeks who survived. Details of the natural history, subsequent pregnancy course and perinatal and maternal outcomes in this case are presented.
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Affiliation(s)
- Enrique Gomez
- Department of Obstetrics and Gynecology, Hospital San Juan de Dios, Universidad Catolica del Norte, La Serena, Coquimbo, Chile
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A rare case of term viable secondary abdominal pregnancy following rupture of a rudimentary horn: a case report. J Med Case Rep 2009; 3:38. [PMID: 19178737 PMCID: PMC2640409 DOI: 10.1186/1752-1947-3-38] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 01/29/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Abdominal pregnancy is a rare event, but one that represents a grave risk to the health of the pregnant woman. An abdominal pregnancy is defined as an ectopic pregnancy that implants in the peritoneal cavity. Early abdominal pregnancy is self-limited by hemorrhage from trophoblastic invasion with complete abortion of the gestational sac that leaves a discrete crater. Advanced abdominal pregnancy is a rare event, with high fetal and maternal morbidity and mortality. CASE PRESENTATION This is a case report of a 22-year-old primigravida with an abdominal pregnancy from a ruptured rudimentary horn. She was diagnosed as a case of term pregnancy with placenta previa with a transverse fetal lie and cervical fibroid and was prepared for an elective cesarean section. Intra-operatively, a live term female baby was extracted from the peritoneal cavity and it turned out to be an abdominal pregnancy from a ruptured rudimentary horn of a unicornuate uterus, which is a very rare condition. Mother and baby were in good condition after such a catastrophic event. CONCLUSION This case illustrates a rare obstetric condition which can be a severe catastrophic condition leading to maternal mortality and morbidity. It is imperative for every obstetrician to have in mind the possibility of abdominal pregnancy, although rare, especially in pregnant patients with persistent abdominal pain and painful fetal movements.
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Hong JH, Shin JH, Song KJ, Lee HJ, Kim IS, Lee JK, Saw HS. Laparoscopic Management of Primary Omental Pregnancy. J Minim Invasive Gynecol 2008; 15:640-1. [DOI: 10.1016/j.jmig.2008.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 04/01/2008] [Accepted: 04/04/2008] [Indexed: 11/27/2022]
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Primary twin omental pregnancy: report of a rare case and literature review. Fertil Steril 2008; 90:2006.e13-5. [PMID: 18555229 DOI: 10.1016/j.fertnstert.2008.03.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 03/07/2008] [Accepted: 03/14/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report a very rare case of a primary twin omental pregnancy. DESIGN Case report. SETTING The emergency department of a university teaching hospital. PATIENT(S) A 36-year-old woman. INTERVENTION(S) Partial omentectomy by laparotomy. MAIN OUTCOME MEASURE(S) Laparotomy successfully performed in the case of a twin omental pregnancy. RESULT(S) A 36-year-old woman presented with intense abdominal pain of 3 days' duration, hypotensive, with distended abdomen and signs of peritoneal irritation, and no transvaginal bleeding or evidence of topic pregnancy. Laparotomy showed normal internal genital organs and the presence of a large hemoperitoneum with a twin omental pregnancy. Partial omentectomy was performed. The patient progressed well postoperatively, and subsequent beta-hCG titer was negative. CONCLUSION(S) Primary omental twin pregnancy is extremely rare, and when associated with acute abdomen and large hemoperitoneum, laparotomy is required for treatment.
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Term extrauterine pregnancy in a Nigerian mother: a complication of uterine dehiscence. Arch Gynecol Obstet 2008; 279:75-7. [PMID: 18449557 DOI: 10.1007/s00404-008-0641-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 03/21/2008] [Indexed: 10/22/2022]
Abstract
Abdominal pregnancy is an uncommon but life-threatening form of ectopic pregnancy. It is associated with high maternal/fetal morbidity and mortality. We present a rare case of term abdominal pregnancy resulting from anterior uterine wall dehiscence, in a 36-year-old woman with three previous caesarean sections. The diagnosis was made at laparotomy for the fourth "caesarean section".
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32
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Yi KW, Yeo MK, Shin JH, Kim KA, Oh MJ, Lee JK, Hur JY, Saw HS. Laparoscopic Management of Early Omental Pregnancy Detected by Magnetic Resonance Imaging. J Minim Invasive Gynecol 2008; 15:231-4. [DOI: 10.1016/j.jmig.2007.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 11/09/2007] [Accepted: 11/21/2007] [Indexed: 10/22/2022]
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Abstract
BACKGROUND Advanced abdominal pregnancy is rare, and one that occurs after uterine rupture with delivery of a viable fetus is exceptional. CASE A multiparous patient was admitted at 29 weeks of gestation for conservative management of placenta previa. She complained of intermittent abdominal pain, but repeated assessment suggested that both the patient and the fetus were doing well. At 36 weeks, an abdominal pregnancy was diagnosed with radiological features suggestive of uterine rupture. Laparotomy was performed and a healthy infant was delivered. CONCLUSION Fetal viability was achieved in this case of abdominal pregnancy secondary to uterine rupture after close maternal and fetal surveillance.
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34
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Zeck W, Kelters I, Winter R, Lang U, Petru E. Lessons learned from four advanced abdominal pregnancies at an East African Health Center. J Perinat Med 2007; 35:278-81. [PMID: 17511595 DOI: 10.1515/jpm.2007.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To analyze diagnosis and treatment of four advanced abdominal pregnancies in a low-resource setting of a developing country. METHODS Extrauterine pregnancies occurring between 1997 and 2003 were identified from hospital records of the Mikumi Health Center in Tanzania/East Africa. RESULTS A total of 45 extrauterine pregnancies were diagnosed four of which were advanced and located in the abdominal cavity. At the time of diagnosis, pregnancies were at 33, 34, 36 and 39 weeks of gestation, respectively. All four mothers survived but three of four fetuses died. One child is alive and well three years after delivery. CONCLUSION Abdominal pregnancy is rather difficult to detect in a low-resource setting of a developing country. Persistent abdominal pain and tenderness, as well as fetal movements in the upper abdomen associated with abnormal fetal lie, may lead to its diagnosis. Localizing the fetal heart sounds in the maternal epigastrium especially in patients with abdominal pain may also be helpful in diagnosing an abdominal pregnancy. In addition, the lack of cervical changes or a displaced cervix should lead to the suspicion of an abdominal pregnancy.
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Affiliation(s)
- Willibald Zeck
- Department of Obstetrics and Gynecology, Medical University of Graz, Austria and Mikumi Health Center, Morogoro District, Tanzania, East Africa.
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35
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Teng HC, Kumar G, Ramli NM. A viable secondary intra-abdominal pregnancy resulting from rupture of uterine scar: role of MRI. Br J Radiol 2007; 80:e134-6. [PMID: 17704308 DOI: 10.1259/bjr/67136731] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pre-natal diagnosis of intra-abdominal pregnancy is difficult. Ultrasound has been the frontline modality to date; however, it gives a diagnostic error of 50-90% and its use is disappointing. In recent years, MRI has emerged as an appealing imaging modality. With its good soft tissue contrast and non-ionizing property, it acts as a means of definitive non-invasive assessment before surgical intervention when ultrasound is inconclusive.
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Affiliation(s)
- H C Teng
- Department of Radiology, University of Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia
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36
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Abstract
Ectopic pregnancy is a high-risk condition that occurs in 1.9% of reported pregnancies. Although the clinical triad of pain, bleeding, and amenorrhea is considered very specific for an ectopic pregnancy, ultrasound plays important role in detecting the exact location of the ectopic pregnancy and also in providing guidance for minimally invasive treatment. This article discusses the main sonographic features of ectopic pregnancy at various common and unusual locations. In addition, it provides insight into the role of hormonal markers in the diagnosis and management of ectopic pregnancy.
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Affiliation(s)
- Shweta Bhatt
- Department of Imaging Sciences, University of Rochester Medical Center, University of Rochester School of Medicine, 601 Elmwood Ave., Box 648, Rochester, NY 14642, USA
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37
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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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38
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Brandt AL, Tolson D. Missed abdominal ectopic pregnancy. J Emerg Med 2006; 30:171-4. [PMID: 16567253 DOI: 10.1016/j.jemermed.2005.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Revised: 03/07/2005] [Accepted: 04/01/2005] [Indexed: 11/22/2022]
Abstract
A case of a ruptured 10-week abdominal ectopic pregnancy, originally diagnosed and treated as pelvic inflammatory disease, is reported. The patient was treated surgically and recovered uneventfully. The case is discussed and a review of the literature is presented.
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Affiliation(s)
- Antonio L Brandt
- Madigan Army Medical Center/University of Washington Combined Emergency Medicine Program, Tacoma, Washington 98431, USA
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39
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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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40
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Young RSH, Huang MC, Chen CP. Successful Laparoscopic Management of Primary Abdominal Pregnancy in the Cul-De-Sac. Taiwan J Obstet Gynecol 2005. [DOI: 10.1016/s1028-4559(09)60133-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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41
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Hughes S, Goodyear P, Sansome A. The anaesthetic management of a woman with a 31-week abdominal pregnancy. Int J Obstet Anesth 2004; 10:321-4. [PMID: 15321592 DOI: 10.1054/ijoa.2001.0855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An 18-year-old primigravida was admitted to hospital complaining of abdominal pain and vomiting. An ultrasound examination suggested the diagnosis of advanced abdominal pregnancy and this was confirmed using magnetic resonance imaging. Two days later she underwent operative delivery of a live fetus. The placenta was left in situ as it was attached to a large number of pelvic structures. Such surgery can result in maternal death due to massive haemorrhage as there is no mechanism to stem blood loss from the placental bed. Death can also occur in the post-partum period from septic complications if the placenta is left in situ. The management of such patients requires personnel and equipment to deal with massive and rapid haemorrhage; aortic cross clamping may be required to control bleeding. In this case, surgery and recovery were uneventful.
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Affiliation(s)
- S Hughes
- Shackleton Department of Anaesthetics, Southampton General Hospital, Temona Road, Southampton, SO16 6YD, UK.
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42
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Ramachandran K, Kirk P. Massive hemorrhage in a previously undiagnosed abdominal pregnancy presenting for elective Cesarean delivery. Can J Anaesth 2004; 51:57-61. [PMID: 14709462 DOI: 10.1007/bf03018548] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To report a case of previously undiagnosed abdominal pregnancy diagnosed at the time of Cesarean section for persistent oblique lie. Delivery of the fetus was followed by near catastrophic hemorrhage. The management of massive hemorrhage in the context of the obstetric patient is discussed. CLINICAL FEATURES A 32-yr-old, ASA 1 primigravida was scheduled for elective Cesarean delivery at 38 weeks gestation under general anesthesia for a persistent oblique lie. On opening the abdomen, the extra-uterine position of the fetus became obvious. Delivery of the fetus was accompanied by torrential hemorrhage. A portion of the placenta was non-resectable and, following surgery, the patient was sent to the intensive care unit. The patient continued to lose blood and was returned to the operating room soon after. The abdomen was packed with large swabs and the wound left open. The hemorrhage continued and the application of military anti-shock trousers (MAST suit) helped stem the loss. A total of 36 U of red cells, 20 U of fresh frozen plasma, 7 U of platelets and 10 U of cryoprecipitate were transfused perioperatively. Both the baby and the mother survived. CONCLUSION Massive hemorrhage in obstetric patients is a major test for the anesthetic and obstetric teams. As our experience shows, a multidisciplinary team based approach helped manage this crisis. Obstetric patients are often young and have great physiological reserve. In this case we feel that the MAST suit significantly contributed to the positive outcome.
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Affiliation(s)
- Krishna Ramachandran
- Department of Anesthesia, Birmingham Heartland's, Hospital, Birmingham, United Kingdom
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43
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Rahaman J, Berkowitz R, Mitty H, Gaddipati S, Brown B, Nezhat F. Minimally Invasive Management of an Advanced Abdominal Pregnancy. Obstet Gynecol 2004; 103:1064-8. [PMID: 15121609 DOI: 10.1097/01.aog.0000127946.14387.48] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Advanced abdominal pregnancy is a rare, life-threatening condition that presents a number of challenges. CASE A 29-year-old primigravida with 10 years of secondary infertility and a previous tuboplasty had a 21-week abdominal pregnancy treated with preoperative arterial embolization before laparoscopically assisted fetal delivery. Postoperatively, 4 cycles of methotrexate were administered at 50 mg/m2 intramuscularly every 3 weeks for the retained abdominal placenta. Subsequent spontaneous conception occurred, and a live, full-term infant was delivered by cesarean delivery 17 months later. No adverse sequelae were found during long-term follow-up. CONCLUSION This report demonstrates successful minimally invasive management of an advanced abdominal pregnancy with a multimodal approach that included preoperative arterial embolization, laparoscopically assisted delivery, and judicious use of postoperative methotrexate.
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Affiliation(s)
- Jamal Rahaman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Mount Sinai Medical Center, New York, New York 10029, USA.
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Beddock R, Naepels P, Gondry C, Besserve P, Camier B, Boulanger JC, Gondry J. [Diagnosis and current concepts of management of advanced abdominal pregnancy]. ACTA ACUST UNITED AC 2004; 32:55-61. [PMID: 14736602 DOI: 10.1016/j.gyobfe.2003.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Authors report a case of abdominal pregnancy diagnosed by MRI at 17 SA with prospective follow-up and planned delivery at 37 SA. The diagnosis is clinically suspected when extra-uterine pregnancy risk factors or history of uterine trauma are present. This is confirmed by MRI, which may be considered as the gold standard. A conservative management may be proposed when the diagnosis is made after 20 weeks and under the following conditions: absence of fetal growth malformation, placental implantation remote from the upper abdomen, good maternal condition, close management in a hospital setting of the patient previously informed of the risks and outcomes. Placental location on the uterus seems to be a major positive factor of outcome for these pregnancies. Materno-fetal follow-up is based on physical examination, repeated ultrasonic investigations with Doppler imaging and daily fetal heart rate monitoring. In the absence of complications, a laparotomy should be planned at 34 weeks. The placenta may not be removed when a serious risk of hemorrhage is feared.
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Affiliation(s)
- R Beddock
- Centre de gynécologie et obstétrique, CHU d'Amiens, 124, rue Camille-Desmoulins, 80054 Amiens 1, France.
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Radaelli T, Bulfamante G, Cetin I, Marconi AM, Pardi G. Advanced tubal pregnancy associated with severe fetal growth restriction: a case report. J Matern Fetal Neonatal Med 2003; 13:422-5. [PMID: 12962269 DOI: 10.1080/jmf.13.6.422.425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A case is described of advanced tubal pregnancy associated with severe fetal growth restriction delivered at 27 weeks. The placenta was implanted on the salpinx and on the uterotubal angle. Progressing tubal pregnancy and its placental histological characteristics could be a model of placental dysfunction typically associated with intrauterine growth restriction.
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Affiliation(s)
- T Radaelli
- Department of Obstetrics and Gynecology, DMCO San Paolo, University of Milan, Milan, Italy
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Varma R, Mascarenhas L, James D. Successful outcome of advanced abdominal pregnancy with exclusive omental insertion. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 21:192-194. [PMID: 12601846 DOI: 10.1002/uog.25] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We report the case of an advanced abdominal pregnancy with exclusive omental insertion whose extrauterine location was not established until delivery by Cesarean section at 35 weeks' gestation. It is hard to believe that omental placentation alone would be sufficient to sustain a pregnancy beyond a gestation where the fetus is viable. However, this report challenges such myths and opens the debate as to what represents the minimal placental maternal viscus contact necessary to achieve fetal viability. The case also demonstrates the continuing difficulty in diagnosing this rare but serious condition despite advances in obstetric imaging, and advocates methods to avoid missing the diagnosis, which could be easily incorporated at booking and mid-trimester scans. Apart from this case, few reports describe normal umbilical artery Doppler velocimetry in advanced abdominal pregnancy. There is a paucity of research on suitable clinical investigations prognostic for abdominal pregnancy, although this case provides further evidence for the use of Doppler as a useful surveillance tool in such cases. Finally, this case propagates the ethical and clinical controversy that exists in managing abdominal pregnancy, particularly when diagnosed late after attaining fetal viability. Expectant management may represent a feasible alternative to surgical termination provided the woman is fully informed of the attendant risks and close surveillance of the pregnancy is undertaken.
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Affiliation(s)
- R Varma
- Department of Obstetrics and Gynaecology, Bedford Hospital, Bedford, UK.
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Chung MT, Lin YS, Wu MP, Huang KF. Laparoscopic surgery for omental pregnancy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2002; 9:84-6. [PMID: 11821612 DOI: 10.1016/s1074-3804(05)60110-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 16-year-old girl underwent emergency laparoscopic surgery for what was thought to be hematoperitoneum secondary to extrauterine pregnancy. During the operation, omental pregnancy was diagnosed and treated by laparoscopy. According to Studiford's criterion, this case can be classified as a primary omental pregnancy. When performing laparoscopy for suspected tubal pregnancy with no visible pathologic changes on either tube, careful evaluation of the whole abdominal cavity is necessary so as not to overlook an abdominal pregnancy.
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Affiliation(s)
- Ming-Ting Chung
- Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, No. 901 Chung Hwa Rd, Yung Kang City, Tainan, Taiwan
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Khong TY, Werger AC. Myometrial fibers in the placental basal plate can confirm but do not necessarily indicate clinical placenta accreta. Am J Clin Pathol 2001; 116:703-8. [PMID: 11710687 DOI: 10.1309/m9bf-6jhh-vf2u-2b8t] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Placental basal plate myometrial fibers reflect mild placenta accreta. We tested the hypotheses that a macroscopically disrupted area relates to an area where the placenta is focally adherent and that the incidence of placenta accreta is higher than stated in the literature. Sagittal blocks were taken from the basal plate from macroscopically intact, disrupted, and mixed (viz, at the junction of intactness and disruption) areas, together with an en face block from 90 singleton placentas. Histologic examination revealed that 11 of 23 placentas with a macroscopically disrupted maternal surface and 16 of 67 with a macroscopically intact maternal surface had placental basal plate myometrial fibers, a significant difference. More cases were detected with sampling from the mixed than from the intact area, while sampling from the wholly disrupted area was unrewarding. The en face block also was helpful for detecting myometrial fibers. Extensive and selective sampling of the basal plate revealed a much higher incidence of placental basal plate myometrial fibers. Clinical chart review affirmed that their presence can confirm but does not necessarily correlate with a clinical diagnosis of mild placenta accreta.
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Affiliation(s)
- T Y Khong
- Department of Histopathology, Women's and Children's Hospital, Adelaide, SA, Australia
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Passini R, Knobel R, Parpinelli MA, Pereira BG, Amaral E, de Castro Surita FG, de Araújo Lett CR. Calcified abdominal pregnancy with eighteen years of evolution: case report. SAO PAULO MED J 2000; 118:192-4. [PMID: 11120551 DOI: 10.1590/s1516-31802000000600008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXT The lithopedion (calcified abdominal pregnancy) is a rare phenomenon and there are less than 300 cases reported in the medical literature. CASE REPORT In this case, a 40 year-old patient had had her only pregnancy 18 years earlier, without medical assistance since then. She came to our hospital with pain and tumoral mass of approximately 20 centimeters in diameter. Complementary examinations (abdominal X-ray, ultrasonography and computerized tomography) demonstrated an extra-uterine abdominal 31-week pregnancy with calcification areas. Exploratory laparotomy was performed, with extirpation of a well-conserved fetus with partially calcified ovular membranes.
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Affiliation(s)
- R Passini
- Department of Obstetrics & Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil
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Steyn PS, Gebhardt GS. Advanced extra-uterine pregnancy--a case of fimbrial expulsion of the fetus with complete placental development in the fallopian tube. Eur J Obstet Gynecol Reprod Biol 1999; 87:167-8. [PMID: 10597968 DOI: 10.1016/s0301-2115(99)00094-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A case report is presented of a 30-year-old woman, gravida 3 para 2, presented with an advanced extra-uterine pregnancy with complete development of the placenta in the fallopian tube.
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Affiliation(s)
- P S Steyn
- Department of Obstetrics and Gynaecology, Tygerberg Hospital, University of Stellenbosch Medical School, South Africa.
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