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Diaouga HS, Yacouba MC, Hissen TM, Oumara M, Bako ID, Garba RM, Idi N, Nayama M. Prolonged abdominal pregnancy incidentally discovered during cesarean section: a case report. BMC Pregnancy Childbirth 2024; 24:182. [PMID: 38454394 PMCID: PMC10918929 DOI: 10.1186/s12884-024-06358-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Abdominal pregnancy is a rare medical condition that is still missed in developing countries due to inadequate medical facilities. The clinical indicators manifest in various forms and are nonspecific, making it challenging to diagnose and often leading to delayed detection. However, obstetric ultrasound serves as an essential tool in early detection. Our objective was to share our experience dealing with this condition and emphasise the importance of early ultrasound diagnosis through efficient pregnancy monitoring in our regions. CASE PRESENTATION 35-year-old Black African woman who had ten months of amenorrhea sought consultation due to an absence of active foetal movements. Her pregnancy was of 39 weeks with fetal demise which was confirmed following clinical examination and ultrasound. She underwent cesarean section in view of transverse position of fetus. During cesarean section, the fetus was found within the abdominal cavity with the placenta attached over the left iliac fossa including surface of left ovary. The uterus and right adnexa were within normal limits. A 2600 g macerated fetus with placenta and membranes were extracted without any complications. The maternal outcome was successful. CONCLUSIONS Abdominal pregnancy remained an inadequately diagnosed condition in developing countries. It is imperative to increase awareness among pregnant women regarding high-quality prenatal care, including early obstetric ultrasound, from conception. Meanwhile, healthcare professionals should receive continuous training and the technical platform modernised. To ensure accurate diagnosis, the location of the gestational sac must be identified for every pregnant woman during their initial ultrasound appointment.
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Affiliation(s)
- Hamidou Soumana Diaouga
- Department of Obstetrics and Gynecology, Abdou Moumouni University, Issaka Gazobi Maternity Hospital in Niamey, Niamey, Niger.
| | - Maimouna Chaibou Yacouba
- Department of Obstetrics and Gynecology, Abdou Moumouni University, Issaka Gazobi Maternity Hospital in Niamey, Niamey, Niger
| | - Tidjani Mahamat Hissen
- Department of Radiology, Abdou Moumouni University, General Reference Hospital, Niamey, Niger
| | - Maina Oumara
- Department of Obstetrics Gynecology, Abdou Moumouni University, General Reference Hospital, Niamey, Niger
| | - Inoussa Daouda Bako
- Department of Radiology, Abdou Moumouni University, General Reference Hospital, Niamey, Niger
| | - Rahamatou Madeleine Garba
- Department of Obstetrics and Gynecology, Abdou Moumouni University, Issaka Gazobi Maternity Hospital in Niamey, Niamey, Niger
| | - Nafiou Idi
- Department of Obstetrics and Gynecology, Abdou Moumouni University, Maternity Unit of the Regional Hospital Center of Niamey, Niamey, Niger
| | - Madi Nayama
- Department of Obstetrics and Gynecology, Abdou Moumouni University, Issaka Gazobi Maternity Hospital in Niamey, Niamey, Niger
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Boka Tounga Y, Soumana Diaouga H, Moumouni S, James Didier L, Rachid S. Acute generalized peritonitis revealing an ovarian pregnancy: a case report. Ann Med Surg (Lond) 2024; 86:1234-1237. [PMID: 38333325 PMCID: PMC10849453 DOI: 10.1097/ms9.0000000000001686] [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: 10/30/2023] [Accepted: 12/24/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Abdominal pregnancy is still seen in developing countries due to inadequate medical facilities. The clinical indicators manifest in various forms and are nonspecific, making it challenging to diagnose and often leading to delayed detection. The occurrence of an infectious complication that leads to the development of generalised acute peritonitis is rare. The author present a case of 34-year-old patient who presented with febril generalised acute peritonitis caused by an abdominal pregnancy. The result of the abdominal ultrasound and the serum β-human chorionic gonadotropin (β-HCG) level led to initial diagnostic confusion. Case presentation A 34-year-old primigravida with no medical or surgical history of comorbidity prior consulted in the authors' department for generalised abdominal pain in the context of fever and amenorrhoea for more than 4 months. Physical examination revealed a painful and contracted abdomen. The biological assessment showed white blood cells at 27 100/ul, the haemoglobin level at 11.8 g/dl. The serum β-HCG level was less than 5 UI/l. The abdominal ultrasound noted a peritonitis secondary to an abscess of the appendix. Exploratory laparotmy revealed 200 ml of pus in the peritoneum and a mass in the right iliac fossa at the expense of the ovary with agglutination of the intestines loops. After adesyolysis, a single-piece excision of the mass was performed, the break-in showing a macerated foetus, a right adnexectomy and an appendectomy. The maternal outcome was good. Clinical discussion Abdominal pregnancy remains an inadequately diagnosed condition in developing countries. This case reminds clinicians that abdominal pregnancy remains a differential diagnosis of all abdominal pain in a woman of childbearing age including when the serum β-HCG level was less than 5 UI/l. Conclusion It is imperative to increase awareness among pregnant women about high-quality prenatal care, including early obstetric ultrasound, from conception. Meanwhile, healthcare professionals should receive continuous training and the technical platform modernised.
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Affiliation(s)
- Yahouza Boka Tounga
- Department of Digestive Surgery, Abdou Moumouni University, National Hospital of Niamey
| | - Hamidou Soumana Diaouga
- Abdou Moumouni University in Niamey; Obstetrics and Gynecology Service; Maternity Issaka Gazobi in Niamey, Niamey, Niger
| | - Soufianou Moumouni
- Abdou Moumouni University in Niamey; Obstetrics and Gynecology Service; Maternity Issaka Gazobi in Niamey, Niamey, Niger
| | - Lassey James Didier
- Department of Digestive Surgery, Abdou Moumouni University, National Hospital of Niamey
| | - Sani Rachid
- Department of Digestive Surgery, Abdou Moumouni University, National Hospital of Niamey
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Zheng X, Zhou Y, Sun Z, Yan T, Yang Y, Wang R. Abdominal pregnancy secondary to uterine horn pregnancy: a case report. BMC Pregnancy Childbirth 2023; 23:412. [PMID: 37270533 DOI: 10.1186/s12884-023-05704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/15/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Pregnancy begins with a fertilized ovum that normally attaches to the uterine endometrium. However, an ectopic pregnancy can occur when a fertilized egg implants and grows outside the uterine cavity. Tubal ectopic pregnancy is the most common type (over 95%), with ovarian, abdominal, cervical, broad ligament, and uterine cornual pregnancy being less common. As more cases of ectopic pregnancy are diagnosed and treated in the early stages, the survival rate and fertility retention significantly improve. However, complications of abdominal pregnancy can sometimes be life-threatening and have severe consequences. CASE PRESENTATION We present a case of intraperitoneal ectopic pregnancy with fetal survival. Ultrasound and magnetic resonance imaging showed a right cornual pregnancy with a secondary abdominal pregnancy. In September 2021, we performed an emergency laparotomy, along with additional procedures such as transurethral ureteroscopy, double J-stent placement, abdominal fetal removal, placentectomy, repair of the right uterine horn, and pelvic adhesiolysis, in the 29th week of pregnancy. During laparotomy, we diagnosed abdominal pregnancy secondary to a rudimentary uterine horn. The mother and her baby were discharged eight days and 41 days, respectively, after surgery. CONCLUSIONS Abdominal pregnancy is a rare condition. The variable nature of ectopic pregnancy can cause delays in timely diagnosis, resulting in increased morbidity and mortality, especially in areas with inadequate medical and social services. A high index of suspicion, coupled with appropriate imaging studies, can help facilitate its diagnosis in any suspected case.
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Affiliation(s)
- Xingju Zheng
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Yao Zhou
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Zhucheng Sun
- Department of Vascular Surgery, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Ting Yan
- Department of Gynecology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Yan Yang
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Rongpin Wang
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China.
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Expectant management of advanced abdominal pregnancies: Is it justifiable? Eur J Obstet Gynecol Reprod Biol 2023; 281:99-108. [PMID: 36587447 DOI: 10.1016/j.ejogrb.2022.12.023] [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: 10/17/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/26/2022]
Abstract
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.
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Mulisya O, Barasima G, Lugobe HM, Matumo P, Vahwere BM, Mutuka H, Léocadie Z, Lumika W. Abdominal pregnancy with a live newborn in a low-resource setting: A case report. Case Rep Womens Health 2023; 37:e00480. [PMID: 36683781 PMCID: PMC9845762 DOI: 10.1016/j.crwh.2023.e00480] [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: 11/15/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
Abdominal pregnancy is defined as pregnancy anywhere within the peritoneal cavity, exclusive of tubal, ovarian, or broad ligament locations. It is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be frequently missed in low-resource settings because of poor antenatal healthcare provision, low socioeconomic patient status as well as lack of adequate medical resources. Clinical diagnosis can be difficult and ultrasound scan is helpful during the early stages of gestation but can be disappointing thereafter. A case of abdominal pregnancy in a 25-year-old woman, who presented at 26 weeks of gestation with severe abdominal pain not relieved by any medication, is reported. An emergency laparotomy was undertaken as her vital signs deteriorated. An abdominal pregnancy was found and a live neonate delivered. Ministries of health in developing countries should ensure routine access to ultrasound in early pregnancy. Obstetricians should bear in mind that abdominal pregnancy can present late in gestation.
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Affiliation(s)
- Olivier Mulisya
- Department of Gynecology and Obstetrics, Fepsi hospital, Butembo, Democratic Republic of the Congo,Corresponding author at: Department of Gynecology and Obstetrics, FEPSI hospital, Butembo, Democratic Republic of the Congo.
| | - Guelord Barasima
- Department of Gynecology and Obstetrics, La Breche Medical Center, 00243 La Breche, BENI, Democratic Republic of the Congo
| | - Henry Mark Lugobe
- Department of Gynecology and Obstetrics, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara Uganda, Uganda
| | - Philémon Matumo
- Département de Gynécologie Obstétrique, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Bienfait Mumbere Vahwere
- Surgery Department of Kampala International University, Box 20000, Gbaba Road, kansanga, kampala, Uganda
| | - Hilaire Mutuka
- Département de chirurgie, Institut de Technique Médical, Butembo, Democratic Republic of the Congo
| | - Zawadi Léocadie
- Department of Gynecology and Obstetrics, La Breche Medical Center, 00243 La Breche, BENI, Democratic Republic of the Congo
| | - Wesley Lumika
- Department of Gynecology and Obstetrics, La Breche Medical Center, 00243 La Breche, BENI, Democratic Republic of the Congo
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Legesse TK, Ayana BA, Issa SA. Surviving Fetus from a Full Term Abdominal Pregnancy. Int Med Case Rep J 2023; 16:173-178. [PMID: 36950324 PMCID: PMC10025137 DOI: 10.2147/imcrj.s403180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Background Abdominal pregnancy refers to a rare form of ectopic pregnancy that has been implanted in the peritoneal cavity. Clinical suspicion combined with ultrasound is important for early diagnosis. A surviving fetus from an abdominal pregnancy is extremely rare. Case Presentation Herein we report on a case of advanced abdominal pregnancy in a Gravida-III Abortion-II mother who presented with worsening abdominal pain of 1 week duration associated with fetal movement and managed successfully with an outcome of a live neonate and no maternal complication. Conclusion A live neonate from term abdominal pregnancy is a rare occurrence. Early diagnosis of abdominal pregnancy is crucial to avoid potentially catastrophic maternal complications even though our patient, fortunately, has a smooth postoperative course. A high level of suspicion combined with ultrasound is helpful in reaching a diagnosis. Skill advancement for radiologists and non-radiology professionals involved in obstetric ultrasound is recommended to avoid misdiagnosis, as in our case. Careful post-operative evaluation is important to look for maternal and fetal complications.
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Affiliation(s)
- Tesfaye Kebede Legesse
- Department of Radiology, Addis Ababa University, College of Health Science, Addis Ababa, Ethiopia
- Correspondence: Tesfaye Kebede Legesse, Tel +251911405854, Email
| | - Birhanu Abera Ayana
- Department of Obstetrics and Gynecology, Addis Ababa University, College of Health Science, Addis Ababa, Ethiopia
| | - Semira Abrar Issa
- Department of Radiology, Addis Ababa University, College of Health Science, Addis Ababa, Ethiopia
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Abdominal pregnancy: a case report and review of 17 cases. Arch Gynecol Obstet 2023; 307:263-274. [PMID: 35474494 PMCID: PMC9837172 DOI: 10.1007/s00404-022-06570-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/06/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the clinical characteristics of abdominal pregnancy, and to explore the diagnosis and prognosis of different treatment methods. METHODS The cases of patients with abdominal pregnancy admitted to Peking Union Medical College Hospital between January 1, 1989 and January 1, 2021, were analyzed retrospectively. RESULTS The median age of 17 patients was 34 years (22-42 years); the median gestational duration was 57 days (from 41 days to 32 weeks). Among all 17 patients, 15 (88.24%) presented with abdominal pain. The implantation sites of the gestational sac included the bladder peritoneal reflection, anterior wall of the rectum, omentum, serous membrane of the uterus, and inside or on the surface of uterosacral ligament. In all, only 29.41% cases (5/17) were diagnosed before surgery. All 17 patients were treated via surgery. Further, 58.82% (10/17) patients recovered without complications, 29.41% (5/17) developed fever, 5.88% (1/17) underwent reoperation because of intra-abdominal bleeding, and 5.88% (1/17) developed double lower limb venous thrombosis. All 17 patients survived. CONCLUSION The preoperative diagnosis rate of abdominal pregnancy is low. Planting sites in the pelvic peritoneum and pelvic organs are more common than the others. Laparoscopic surgery in the first trimester of pregnancy can achieve better therapeutic effects. However, the blood supply of the placenta should be fully evaluated before surgery. When it is expected that attempts to remove the placenta will cause fatal bleeding, the placenta can be left in place, but long-term close follow-up should be paid attention to.
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Mushema BN, Nkwama BS, Rweyemamu GA, Makanda IH, Chiduo M. Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report. East Afr Health Res J 2022; 6:11-17. [PMID: 37928869 PMCID: PMC10624215 DOI: 10.24248/eahrj.v6i1.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/29/2022] [Indexed: 11/07/2023] Open
Abstract
Background Abdominal pregnancies are a rare occurrence and are associated with high maternal and perinatal mortality rates compared to intra-uterine and other ectopic pregnancies. Localization of sites of abdominal pregnancies and determining the gestational age at the time of diagnosis play a fundamental role in guiding the treatment approach and minimizing potential complications. However, the vague presentation coupled with low accuracy of ultrasound detection often leads to misdiagnosis of abdominal pregnancy, and hence delaying initiation of appropriate management. We present a case of a second trimester abdominal pregnancy detected following failure of induction for an initial diagnosis of missed abortion, and the ensuing outcome, rarely reported in limited-resource settings. Case presentation A 19 year old unbooked woman, gravida 2 para 1 at 17th week gestation age by ultrasound presented with loss of foetal movement for one week. Based on clinical assessment and referral ultrasound findings, she was initially diagnosed with missed abortion and planned for induction. Failure of induction prompted a repeat ultrasound which revealed a non-viable abdominal pregnancy. Laparotomy was done, localisation of the pregnancy at the omentum was observed and a dead foetus was extracted with the placenta left in-situ. A complication of surgical wound dehiscence with infection developed post-operatively and was managed with secondary sutures. The patient recovered and was discharged in a stable condition. Conclusion This case demonstrates that the diagnosis of abdominal pregnancy remains a challenge especially in settings where skilled human resources for health are few and equipment and supplies for effective and timely treatment are limited. The case sheds some light on the broader challenges in maternal and perinatal health in developing countries. Accurate pre-operative diagnosis requires a high index of suspicion, especially due to the variability of its presentation. This case emphasises the important of quality antenatal care and the need for clinicians to conduct comprehensive assessments of patients and receive training on obstetric ultrasound skills.
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Affiliation(s)
- Beata Nyangoma Mushema
- Department of Obstetrics and Gynaecology, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | | | | | - Isaac Hamis Makanda
- Department of Obstetrics and Gynaecology, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Monica Chiduo
- Department of Obstetrics and Gynaecology, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
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