Effect of antenatal class attendance on fear of childbirth and antenatal stress

ABSTRACT OBJECTIVE To assess the effect of attending antenatal classes on fear of childbirth and antenatal stress in nulliparous pregnant women. METHODS A total of 133 nulliparous pregnant women participated in the study, which had a quasi-experimental design. Data were collected by a descriptive data form, the Wijma Delivery Expectancy/Experience Questionnaire, and the Antenatal Perceived Stress Inventory (APSI). RESULTS A significant correlation was found between antenatal class attendance and having a high schooling level and an intended pregnancy (p < 0.05). The mean fear of childbirth score of pregnant women was 85.50 ± 19.41 before the training and 76.32 ± 20.52 after the training, and the difference between these scores was significant (p < 0.01). Fear of childbirth score were not significantly different between the intervention group and the control group. The mean APSI score of pregnant women in the intervention group was 22.32 ± 6.12 before the training and 21.79 ± 5.97 after the training. However, this difference was not statistically significant (p = 0.70). CONCLUSION The fear of childbirth score decreased significantly in the intervention group after the training.

Embarazo ectópico abdominal de 23 semanas en primigestante. Reporte de caso

El embarazo ectópico abdominal es una patología poco frecuente, la cual consiste en un embarazo con implantación dentro de la cavidad abdominal y fuera del útero y sus anexos; siendo el menos frecuente de los embarazos ectópicos, y representando el 1 % de los casos. Sin embargo, cuando se presenta, la tasa de mortalidad materno-fetal es alta, por lo que representa una urgencia médica con complicaciones graves como hemorragia obstétrica. El diagnóstico requiere un alto grado de sospecha, debido a que el sangrado menstrual regular puede estar presente. Se presenta el caso de una paciente primigestante con embarazo ectópico abdominal en segundo trimestre, con manejo definitivo quirúrgico y posterior evolución materna favorable al postquirúrgico, sin embargo, con resultado perinatal adverso para el recién nacido. La importancia de este caso radica en su diagnóstico oportuno, por el cual se logró evitar complicaciones que pusieran en riesgo la vida de la paciente.

Abdominal ectopic pregnancy is a rare pathology, it is expressed by a pregnancy with implantation inside the abdominal cavity and outside the uterus and its annexes, being specifically the least frequent of ectopic pregnancies, representing 1% of cases. When it occurs, the maternal-fetal mortality rate is high1. The diagnosis requires a high degree of suspicion, due to regular menstrual bleeding may be present. It is a medical emergency with serious complications such as obstetric hemorrhage. We present the case of a prime pregnant patient with abdominal ectopic pregnancy in the second trimester with definitive surgical management, and subsequent maternal evolution favorable to post-surgery, however, with adverse perinatal outcome for the newborn. The importance of this case lies in its timely diagnosis, by which it was possible to avoid complications that put the patient's life at risk.

Embarazo abdominal a término con recién nacido vivo sin malformaciones. Reporte de caso: revisión de la bibliografía / Abdominal term pregnancy with a live newborn without malformations. Case report: literature review

Resumen ANTECEDENTES: El embarazo abdominal representa el 1% de los embarazos ectópicos, con una mortalidad materna que puede alcanzar, incluso, hasta el 20% y una mortalidad fetal hasta del 90%. CASO CLÍNICO: Paciente de 31 años, en curso de las 39 semanas del segundo embarazo. El primero se atendió, sin complicaciones, en el domicilio cuando tenía 25 años; enseguida se le indicó, como método anticonceptivo, acetato de medroxiprogesterona inyectable trimestral. Acudió al Hospital Regional Docente de Cajamarca debido a un dolor abdominal luego de siete controles prenatales. Se ingresó al servicio de Obstetricia al tercer día con pródromos de labor de parto, feto en transverso y placenta previa. En la cesárea de urgencia el útero se encontró de 18 cm, la placenta adherida al epiplón, intestino, colon sigmoide, recto y pared izquierda del útero. Se obtuvo una recién nacida con Apgar 8-9, sin malformaciones. Se practicaron: extracción de la placenta, histerectomía abdominal subtotal y salpingooforectomía izquierda. El sangrado intraoperatorio fue de 1800 mL por lo que ameritó la transfusión de dos paquetes globulares. La madre y su hija evolucionaron favorablemente por lo que se dieron de alta del hospital, sin complicaciones. CONCLUSIÓN: El embarazo abdominal es un evento raro, sobre todo si llega a término y con un recién nacido vivo saludable. A pesar de los estudios ultrasonográficos, el embarazo abdominal no es de diagnóstico fácil; por eso casi todos se diagnostican durante la cirugía. Si la placenta no afecta estructuras vasculares extensas, ni órganos abdominopélvicos, podrá retirse, con cuidados extremos, para no originar males mayores.

Abstract BACKGROUND: Abdominal pregnancy represents 1% of ectopic pregnancies, with a maternal mortality that can reach up to 20% and a fetal mortality of up to 90%. CLINICAL CASE: 31-year-old female patient, in the course of 39 weeks of her second pregnancy. The first pregnancy was attended, without complications, at home when she was 25 years old; she was immediately prescribed quarterly injectable medroxyprogesterone acetate as a contraceptive method. She went to the Regional Teaching Hospital of Cajamarca due to abdominal pain after seven prenatal check-ups. She was admitted to the obstetrics service on the third day with prodromes of labor, transverse fetus and placenta previa. In the emergency cesarean section the uterus was found to be 18 cm, the placenta adhered to the omentum, intestine, sigmoid colon, rectum and left wall of the uterus. A newborn was obtained with Apgar 8-9, without malformations. Placental extraction, subtotal abdominal hysterectomy and left salpingo-oophorectomy were performed. Intraoperative bleeding was 1800 mL, which required the transfusion of two packs of red blood cells. The mother and daughter evolved favorably and were discharged from the hospital without complications. CONCLUSION: Abdominal pregnancy is a rare event, especially if it is carried to term with a healthy live newborn. Despite ultrasonographic studies, abdominal pregnancy is not easily diagnosed; therefore almost all are diagnosed during surgery. If the placenta does not affect extensive vascular structures or abdominopelvic organs, it can be removed, with extreme care, so as not to cause greater harm.

Embarazo Ectópico Abdominal

Resumen Se presenta el caso clínico de una paciente de sexo femenino de 36 años, atendida en el Hospital Japonés (HJ) de la ciudad de Santa Cruz, ingreso a nuestro hospital con cuadro clínico de abdomen agudo y cursando embarazo de 20 semanas, con antecedente de relevancia de aborto por embarazo ectópico hace tres años, se realiza laparotomía exploratoria en la que se evidencia embarazo abdominal, se efectúa extracción del feto y de placenta, se coloca packing y se deja en laparotomía contenida, después de 72 hrs se realiza limpieza y cierre de pared, paciente con buena evolución clínica.

Abstract We present the clinical case of a 36-year-old female patient, treated at the Hospital Japonés (HJ) in the city of Santa Cruz, who was admitted to our hospital with a clinical presentation of acute abdomen and a 20-week pregnancy, with a relevant history of abortion due to an ectopic pregnancy three years ago, Exploratory laparotomy was performed in which abdominal pregnancy was evidenced, the fetus and placenta were extracted, packing was placed and left in contained laparotomy, after 72 hours cleaning and closure of the abdominal wall was performed, patient with good clinical evolution.

Embarazo ectópico abdominal: reporte de dos casos / Abdominal ectopic pregnancy: Report of two cases / Abdominal ectopic pregnancy: Report of two cases

RESUMEN Presentamos dos casos de embarazo ectópico abdominal de 16 y 26 semanas, evaluados con ecografía y resonancia magnética. Ambos casos ingresaron con cuadro de abdomen agudo quirúrgico, el de mayor edad gestacional con descompensación hemodinámica por hemoperitoneo secundario a desprendimiento placentario. La presentación clínica conllevó a la resolución por laparotomía y extracción del feto y del tejido placentario, terminando el primer caso en histerectomía por compromiso trofoblástico de la superficie uterina y órganos adyacentes. El neonato de 26 semanas falleció luego de 4 meses, por sepsis tardía. La sospecha clínica por amenorrea y dolor abdominal intenso son criterios importantes, y los estudios de imágenes, especialmente la ecografía transvaginal y pélvica, son las principales herramientas diagnósticas.

ABSTRACT We present two cases of abdominal ectopic pregnancy of 16 and 26 weeks, evaluated with ultrasound and magnetic resonance imaging. Both cases presented an acute surgical abdomen, the case with the oldest gestational age showed hemodynamic decompensation due to hemoperitoneum secondary to placental abruption. The clinical presentation led to resolution by laparotomy and extraction of the fetus and placental tissue, ending in hysterectomy due to trophoblastic involvement of the uterine surface and adjacent organs in the first case. The 26-week-neonate died after 4 months due to late sepsis. Clinical suspicion for amenorrhea and severe abdominal pain are important criteria, and imaging studies, especially ultrasound, are the main diagnostic tools.

Embarazo con implantación en histerorrafia de cesárea anterior: caso clínico poco frecuente / Pregnancy implanted in previous cesarean section scar: a rare clinical case

Introducción: el embarazo ectópico se produce cuando el embrión se implanta fuera de la cavidad uterina, y se ubica mayormente en las trompas de Falopio. Objetivo: presentar un caso clínico en el que la paciente desarrolló un embarazo ectópico en la cicatriz de una histerorrafia previa, fue diagnosticada cuando cursaba la sexta semana de gestación y se resistió ante la idea de perderlo irremediablemente, aunque su cuadro clínico es muy doloroso y se complica rápidamente. Presentación del caso: paciente de 27 años de edad, de color de piel negra, con antecedente de cesárea previa 9 meses atrás. Según reporte ecográfico se diagnostica embarazo de 8,6 semanas de gestación localizado en la zona de cicatriz de cesárea previa. Recibe tratamiento inicial con metotrexate y cloruro de potasio, para luego ser intervenida quirúrgicamente a través de legrado instrumental, se corrobora diagnóstico ecográfico y se logra extraer el embrión exitosamente. Conclusión: el manejo atendió a las características clínicas e individuales de la gestante y se respetó el principio de autonomía de la embarazada. La paciente pudo ser dada de alta con un estado de salud satisfactorio, conservó su capacidad de fecundidad(AU)

Introduction: Ectopic pregnancy occurs when the embryo is implanted outside the uterine cavity, mostly located in the fallopian tubes. Objective: To present a clinical case in which the patient developed an ectopic pregnancy over a previous cesarean section scar; the diagnosis was made when she was in the sixth week of her pregnancy and she could not withstand the idea of losing the baby, but the clinical picture worsened, she was very painful and became complicated quickly. Case report: Twenty-seven-year-old black patient with previous history of a cesarean section 9 months ago. According to ultrasound criteria, 8.6 weeks of pregnancy located in the area of a previous cesarean section scar is diagnosed. The patient receives initial treatment with methotrexate and potassium chloride to undergo a surgical procedure through instrumental intervention (curettage), confirming the diagnosis of the ultrasound and removing the embryo successfully. Conclusions: The management was based on the clinical and individual characteristics of the pregnant woman respecting the principle of autonomy. The patient was in good health at the moment of discharge, preserving her fertility capacity(AU)

Innovative use of tourniquet in the management of an advanced abdominal pregnancy to achieve an unusually normal postoperative outcome: a case report

Mrs. UVG was an un-booked G3P1+1 petty trader, who presented with an obstetric ultrasound scan report, with an incidental diagnosis of abdominal pregnancy at 32 weeks of gestation with the placenta attached to the fundus of the uterus. Her admission packed cell volume was 24%. She had pre-operative preparation and 2 units of compatible blood were transfused to correct the anemia. Four additional units of compatible blood were made available before she was scheduled for an exploratory laparotomy at 33 weeks of gestation. A grossly normal male infant weighing 2.2 kg was delivered from the peritoneal cavity with Apgar scores of 2 at 1 minute and the same at 5 minutes. The placenta which was attached to the fundus of the uterus was removed manually completely after a tourniquet had been applied distal to the point of separation. Intra-operative blood loss was 1000 ml. The infant died 1 hour after delivery due to respiratory failure. Autopsy report revealed massive intracerebral hemorrhage and pulmonary hypoplasia. The post-operative period was uneventful and the decline in serum assay of β-human chorionic gonadotrophin postpartum was normal. She was discharged home on the 8th post-operative day and seen at the postnatal clinic twice at weekly intervals with normal serum assay of β-human chorionic gonadotrophin. Her 6 weeks postnatal visit was also uneventful.

A rare case of abdominal pregnancy: diagnostic and therapeutic challenges

Abdominal pregnancy refers to a pregnancy that has implanted in the abdominal cavity, the estimated incidence being 1 per 30,000 births. A 36-year-old primigravida with term pregnancy with fetal demise was referred to us. Examination was suggestive of single foetus of 30 weeks’ gestation with longitudinal lie and cephalic presentation with absent foetal heart sounds. The cervical os was closed, uneffaced. Ultrasound done at 18 weeks’ gestation had reported pregnancy in a bicornuate uterus. Present ultrasound revealed intrauterine foetal demise of 28.4 weeks. Cervical ripening, done using prostaglandins, mechanical dilation with Foley’s catheter and oxytocin, had failed, and thus patient was taken up for surgery. Findings revealed an abdominal pregnancy with a macerated fetus of 1070 grams (severely growth restricted). Placenta was found to be implanted on multiple areas of both small and large intestine and posterior peritoneum. Placenta was left in situ. Postoperative recovery was uneventful. She was given higher antibiotics, 4 doses of tablet mifepristone 200 mg and monitored regularly with ultrasound/ MRI and bHCG which showed slow placental resorption. Conclusion- Abdominal pregnancies, associated with a high maternal and perinatal morbidity and mortality, are diagnosed preoperatively only in 45% of cases. Thus, a high index of suspicion and improvement in diagnosis is the need of the hour. Successful management includes prompt intraoperative recognition and management of the placenta (we advocate leaving the placenta in situ), multidisciplinary approach with involvement of surgeons and interventional radiologists, access to blood products, meticulous postoperative care and close observation during the subsequent delayed reabsorption.

Manejo expectante de gestación ectópica abdominal tras fecundación in vitro en paciente con salpinguectomía bilateral: reporte de un caso / Expectant management of abdominal ectopic pregnancy following in vitro fertilization in a patient with previous bilateral salpinguectomy: a case report

ANTECEDENTES El embarazo ectópico abdominal es el menos habitual de los embarazos ectópicos, con una prevalencia situada entre el 0.9 - 1.4%. La mortalidad materna es elevada, alcanzando un 20% y la viabilidad fetal mínima. El manejo médico en estas situaciones es complicado ya que no está bien establecido debido a su baja frecuencia. CASO CLÍNICO Mujer de 35 años, con antecedente de esterilidad por endometriosis y salpinguectomía bilateral. Tras 5 fecundaciones in vitro (FIV) consigue una primera gestación, con finalización mediante cesárea por no progresión de parto. Acude a urgencias en su segundo embarazo, logrado tras 3 (FIV), con edad gestacional de 7 semanas. Presenta sangrado vaginal escaso y la ecografía demuestra a nivel de Douglas y hacia fosa iliaca izquierda un saco gestacional de 3 cm con embrión sin latido cardiaco de 5 mm. El nivel de β-hcg es de 1477 mUI/ml. Se diagnostica de gestación ectópica abdominal y se opta por actitud expectante dada la estabilidad clínica de la paciente. En un control a las 48h la β-Hcg es de 464 mUI/ml y la paciente se mantiene estable. En controles posteriores se observan niveles descendentes de β-Hcg y tras un mes la resolución es completa. CONCLUSIÓN El embarazo ectópico abdominal es una entidad poco frecuente pero con una alta tasa de mortalidad. Aunque lo más común es optar por un abordaje quirúrgico es necesario individualizar cada caso y basarse en la clínica y las diferentes pruebas diagnósticas para seleccionar aquellos casos que se pueden beneficiar de un manejo conservador.

BACKGROUND Abdominal ectopic pregnancy accounts for only 0.9-1.4% of all ectopic pregnancies. The maternal mortality rate is high (up to 20%) and fetal viability mínimum. The managment, specially the conservatory management of these cases is difficult because of our limited experiencie due to its low frecuency. CASE PRESENTATION 35-year-old woman, with history of sterility due to endometriosis that required bilateral laparoscopic salpinguectomy. Her first pregnancy (after 5 in vitro fertilization cicles (IVF)) finalized with a caesarean section because of to the lack of labour progresion. She was admitted to our emergency department during her second pregnancy (after 3 IVF cicles), with 7 weeks of gestational age. She had a little vaginal bleeding. Ultrasound scan showed a 5mm gestational sac with a 3mm embryo without cardiac activity in the pouch of Douglas. The β-Hcg level was 1477mUI/ml. The final diagnosis was ectopic abdominal pregnancy and it was decided to undertake an expectant management because she was clinically stable. The β-Hcg level after 48 hours was 464 mUI/ml. In subsequent examinations β-Hcg showed descending levels and after one month the resolution was completed. CONCLUSION Abdominal ectopic pregnancy is very infrequent but it has a high mortality rate. The most common approach is surgical but it is necessary to study all signs and diagnostic tests to select patients that could get profit from a conservatory management.

Abdominal pregnancy misdiagnosed as an intrauterine pregnancy: a cause of failed induction of labour for fetal death

Abdominal pregnancy is a rare form of ectopic pregnancy usually associated with fetal death among other complications, although very rare cases of live births have been reported. There is also a high risk of maternal mortality. A high index of suspicion is required to make a preoperative diagnosis as diagnosis from history, examination and ultrasound is often missed. Misdiagnoses as an intrauterine pregnancy usually occur. This misdiagnosis makes management of patients with an abdominal pregnancy a challenge and may affect treatment outcome. We managed a 35 year old pregnant multipara who was referred to us on account of repeated failed attempts at induction of labour for intrauterine fetal death. Three obstetric ultrasound scans done during the course of patient’s management reported an intrauterine dead fetus. We also failed to achieve uterine evacuation. We resorted to carry out a hysterotomy and following laparotomy, we found an abdominal pregnancy. This finding was unexpected by us, however, we delivered the dead fetus and was able to successfully manage the placenta. Discovering an abdominal pregnancy at surgery carried out for a supposed intrauterine pregnancy is usual for many cases of abdominal pregnancy. Clinicians should be aware of the clinical signs and symptoms that raise a suspicion of abdominal pregnancy as prompt preoperative diagnosis of abdominal pregnancy helps to plan and offer early and appropriate intervention. This reduces the incidence of maternal mortality usually due to massive intra-abdominal haemorrhage arising from delayed diagnosis and poor placenta management.

Embarazo abdominal postérmino: Reporte de un caso / Post-term abdominal pregnancy, a case report

Abdominal ectopic pregnancy is a dramatic situation for the woman's health. It is a rare pathology that proves to be a difficult test even for the most experienced gynecologists in diagnostic ability, decision-making and surgical technique. We present the case of a hospitalized post-term ectopic abdominal pregnancy with a dead fetus inside the chorioamniotic sac and the placenta implanted on vital abdominal viscera. We describe the clinical data, operative findings and conservative management of the retained placenta, followed by a bibliographic review on the subject.

El embarazo ectópico abdominal representa una situación dramática para la salud de la mujer. Al ser una patología poco frecuente, resulta al ginecólogo una prueba difícil para habilidad diagnóstica, capacidad de decisión y técnica quirúrgica, incluso para el más experto. Se presenta un caso de embarazo ectópico abdominal postérmino, que llegó con óbito fetal dentro de la bolsa corioamniótica y la placenta implantada sobre vísceras abdominales. Se describe los datos clínicos, hallazgos operatorios y el manejo conservador de la placenta retenida, y se hace una revisión bibliográfica del tema.

Lithopedion causing intestinal obstruction in a 71-year-old woman: A case report / Litopedia causando obstrução intestinal em idosa de 71 anos: relato de caso

Abstract Ectopic pregnancy is the leading cause of pregnancy-related death during the first trimester, and it occurs in 1 to 2% of pregnancies. Over 90% of ectopic pregnancies are located in the fallopian tube. Abdominal pregnancy refers to an ectopic pregnancy that has implanted in the peritoneal cavity, external to the uterine cavity and fallopian tubes. The estimated incidence is 1 per 10,000 births and 1.4%of ectopic pregnancies. Lithopedion is a rare type of ectopic pregnancy, and it occurs when the fetus from an unrecognized abdominal pregnancymay die and calcify. The resulting "stone baby" may not be detected for decades andmay cause a variety of complications. Lithopedion is a very rare event that occurs in 0.0054% of all gestations. About 1.5 to 1.8% of the abdominal babies develop into lithopedion. There are only ~ 330 known cases of lithopedion in the world. We describe a lithopedion that complicated as intestinal obstruction in a 71-year-old woman.

Resumo A gravidez ectópica é a principal causa de morte materna no primeiro trimestre, e ocorre em 1 a 2% das gestações. Mais de 90% ocorrem nas tubas uterinas. Gravidez abdominal refere-se à gravidez ectópica implantada na cavidade peritoneal, externamente ao útero e às tubas uterinas.Aincidência estimada éde 1 por 10mil nascimentos e 1,4%das gravidezes ectópicas. A litopedia é um tipo raro de gravidez ectópica, e ocorre quando o feto de uma gravidez abdominal não reconhecida morre e se calcifica. O "bebê de pedra" resultante pode não ser detectado por décadas, e pode causar complicações futuras. A litopedia é um evento muito raro que ocorre em 0,0054% de todas as gestações. Cerca de 1,5 a 1,8% dos bebês abdominais se tornam litopédios. Existem somente cerca de 330 casos conhecidos de litopedia no mundo. Descrevemos uma litopedia que se agravou, tornando-se uma obstrução intestinal, em uma idosa de 71 anos.

A successful management of an advanced secondary abdominal pregnancy with a live fetus: A case report / Philippine Journal of Obstetrics and Gynecology

@#Advanced abdominal pregnancy is associated with catastrophic outcomes for both mother and fetus. Because it is rare, it is often misdiagnosed and the surgery, often unplanned, may end up with uncontrollable hemorrhage and injury to abdominal structures during placental removal. A case of a 21-year-old G1P0, 34 weeks gestation, who presented as a bleeding placenta previa but diagnosed intraoperatively as abdominal pregnancy with a live baby with congenital anomalies, with complete removal of the placenta and with good maternal outcome is presented. This report highlights the pitfalls in diagnosis and stresses the importance of team management, adherence to good surgical principles, and timely operative decisions to ensure a successful outcome when preoperative evaluation is not possible.

Embarazo ectópico abdominal de término con neonato vivo: caso clínico y revisión de la bibliografía / Advanced abdominal pregnancy with a living neonate: Case report and literature review

Resumen ANTECEDENTES: El embarazo ectópico abdominal es una alteración poco frecuente, pero con alta tasa de morbilidad y mortalidad materno-fetal-neonatal. Para establecer el diagnóstico se requiere un alto grado de sospecha y casi siempre se efectúa durante el procedimiento quirúrgico. Es el único tipo de embarazo ectópico que puede llegar a término. CASO CLÍNICO: Paciente de 35 años, con antecedente obstétrico de dos cesáreas, que acudió al servicio médico por dolor abdominal de larga evolución, con varios meses de amenorrea, sin control prenatal. El dolor fue inicialmente adjudicado a una hernia umbilical, pero ante su persistencia se reexaminó a la paciente y se encontró una masa abdominal, por lo que se sospechó embrazo ectópico. El ultrasonido abdominal y la resonancia magnética confirmaron el embarazo de término, que finalizó mediante laparotomía. Se decidió dejar la placenta in situ, debido al riesgo de hemorragia por su remoción. Tanto el neonato como la madre fueron dados de alta en buenas condiciones después de dos semanas de estancia hospitalaria, con posterior seguimiento. CONCLUSIONES: Aunque el embarazo ectópico abdominal es una alteración poco frecuente, es importante saber qué debe hacerse de acuerdo con las semanas de gestación, debido al incremento reciente en su incidencia y a la alta tasa de complicaciones, con la finalidad de preservar el bienestar materno-fetal y la fertilidad femenina.

Abstract BACKGROUND: Abdominal pregnancy is a rare clinical entity with a high risk for both the mother and the product. It's diagnosis requires a high level of suspicion, being usually made during the surgical management of the case. It is the only type of ectopic pregnancy that can reach term. CLINICAL CASE: A 35 year-old patient, with two previous cesarean deliveries, who presents with chronic abdominal pain, without prenatal consultations and with several months of amenorrhea. The pain is initially atributted to an umbilical hernia, but due to it's persistence she is re-examined, finding an abdominal mass and raising suspicion of a possible ectopic pregnancy. She's sent to a hospital in western Mexico, where she undergoes abdominal examination with ultrasound and magnetic resonance, which shows a full term abdominal pregnancy, for which a laparotomy is performed. The placenta is left in situ, due to the high risk of hemorrhage associated with it's removal. Both the newborn and the mother are released from the hospital in good conditions after two weeks of stay, with subsequent follow-up. CONCLUSIONS: Despite it being a rare condition, it's important to be acquainted with the proper management according to the gestational age of the pregnancy due to the recent rise in it's incidence, as well as it's particularly high rate of complicactions, in order to preserve the wellbeing of both patients when possible, as well as maternal fertility.

Embarazo ectópico abdominal en una paciente histerectomizada / Ectopic abdominal pregnancy in a patient hysterectomized

Resumen Antecedentes: El embarazo ectópico abdominal es una alteración obstétrica poco frecuente, sobre todo en pacientes con antecedente de histerectomía. Los síntomas suelen ser inespecíficos y el diagnóstico se retrasa por la baja sospecha clínica, con el subsiguiente aumento en la morbilidad y mortalidad materna. Caso Clínico: Paciente de 33 años, con antecedentes ginecoobstétricos de tres cesáreas e histerectomía subtotal posparto por placenta acreta, que acudió al servicio médico por dolor abdominal y sangrado vaginal. En la ecografía se visualizó el saco gestacional con embrión de 12 + 4 semanas y latido cardiaco positivo. Se indicó laparotomía urgente por abdomen agudo y sospecha de embarazo ectópico abdominal; durante el procedimiento se evidenció el saco gestacional de 7 cm, adherido al colon sigmoide y al remanente cervical, con rotura sangrante hacia la cavidad abdominal que englobaba el anejo izquierdo. Se practicó resección del embarazo ectópico y anexectomía izquierda, en colaboración con el servicio de Cirugía general. El posoperatorio transcurrió sin incidentes y la paciente fue dada de alta satisfactoriamente. Conclusiones: Es importante incluir el embarazo ectópico en el diagnóstico diferencial de abdomen agudo, incluso en pacientes con antecedente de histerectomía.

Abstract Background: Abdominal ectopic pregnancy is a rare condition in obstetrics, especially if there is a history of hysterectomy. Symptoms are usually nonspecific and the diagnosis is often delayed by low clinical suspicion, with consequent increase in maternal morbi-mortality. Clinical case: 33 year-old patient with 3 previous cesareans and subtotal hysterectomy postpartum for placenta accreta, referred by abdominal pain and vaginal bleeding. In the gynecological ultrasound, a gestational sac was visualized with an embryo according to 12 + 4 weeks, with positive heartbeat. Urgent laparotomy was indicated for acute abdomen and suspicion of abdominal ectopic pregnancy, showing a gestational sac of 7 centimeters adhered to sigma and cervical stump with a bleeding broken zone to abdominal cavity that enclosed left annex, reason why resection of ectopic gestation and left annexectomy was performed in collaboration with General Surgery Service. The postoperative period was without consequences and the patient was satisfactorily discharged. Conclusions: It is important to include this entity within the differential diagnosis of acute abdomen women of childbearing age, even if a previous hysterectomy has been performed.

A secondary abdominal pregnancy with unusual placental implantation in the fallopian tube: a diagnostic challenge

We reported a case of secondary abdominal pregnancy with placental implantation into the fallopian tube, diagnosed at 16 weeks, in a woman admitted to the emergency room complaining of syncopal attacks. The best approach would be termination of the pregnancy, taking into consideration the high risk to the mother and the low possibility of alive and healthy birth. We had to perform an urgent surgical intervention due to the fact that the patient was in a clinically unstable condition, which was related to hemoperitoneum. If placental implantation is on abdominal organs or vessel the best approach would be to ligate the cord and to leave placenta in situ. Taking into consideration the place of placental implant, the removal of the fallopian tube with the placenta was the safest approach in this case. The best and most acceptable form of treatment would be individualized in case of rare form of ectopic pregnancy.

Embarazo ectópico abdominal avanzado: reporte de casos y revisión de la literatura / Advanced ectopic abdominal pregnancy: Case report and review of the literature

RESUMEN Objetivo: Reportar dos casos de embarazo ectópico abdominal avanzado, con buen resultado materno / perinatal, y revisar la literatura disponible con respecto al manejo de la placenta y el pronóstico de esta entidad. Materiales y métodos: Se describen dos casos de embarazo ectópico abdominal avanzado en los que se realizó extracción de la placenta, con feto viable y resultado perinatal favorable. Estos fueron atendidos en una institución de cuarto nivel de complejidad,ubicada en la ciudad de Cali, Colombia. Se realizó una revisión de la literatura registrada en las bases de datos Medline vía PubMed, con los términos de búsqueda: "embarazo abdominal", "embarazo esplénico", "embarazo hepático", "embarazo omental" y "embarazo peritoneal". La búsqueda se limitó a artículos publicados durante los últimos doce años en inglés y español. Resultados: Se recuperaron 228 referencias, de las cuales 42 artículos cumplieron con los criterios de inclusión que informan un total de 74 pacientes con embarazo ectópico abdominal. En cuanto al manejo de la placenta, la remoción de la misma se informó en 42 casos (58%). La mortalidad materna se presentó en 4 casos (4,1%), todos por hemorragia posparto. Un total de 60 pacientes (81%) presentaron complicaciones, la más frecuente fue hemorragia en 38 de ellas (51%). En cuanto al resultado perinatal, se encontró una mortalidad perinatal del 43%. Conclusión: El manejo de la placenta es el punto clave del que podría depender la frecuencia de complicaciones maternas. Se requieren estudios prospectivos que evalúen el manejo más seguro y efectivo de esta condición.

ABSTRACT Objective: Report two cases of advanced ectopic abdominal pregnancy with good maternal/perinatal outcomes, and to review the literature available regarding the management of the placenta and the prognosis for this condition. Materials and methods: Description of two cases of advanced ectopic abdominal pregnancies with viable fetuses and favourable perinatal outcomes, in which the placenta was removed. The cases were seen at a Level IV institution in the city of Cali, Colombia. Review of the literature registered in the Medline data base via Pubmed using the search terms "abdominal pregnancy", "splenic pregnancy", "hepatic pregnancy", "omental pregnancy" and "peritoneal pregnancy". The search was limited to articles published in English and Spanish during the past 12 years. Results: Overall, 228 references were retrieved, of which 42 articles reporting on a total of 74 patients with ectopic abdominal pregnancy met the inclusion criteria. Regarding the management of the placenta, it was removed in 42 cases (58%). There were 4 cases of maternal mortality (4,1%) all of them due to postpartum bleeding. Complications occurred in 60 patients (81%), bleeding being the most frequent in 38 of them (51%). As for perinatal outcome, perinatal mortality was 43.8%. Conclusion: Placental management is the the key determinant factor of the frequency of maternal complications. Prospective studies to assess the safest and most effective management of this condition are required.

Embarazo abdominal: caso clínico y revisión de literatura / Abdominal pregnancy: a clinic case and literature review

En este artículo se informa un caso y se revisa la literatura acerca de embarazo abdominal. Se reporta el caso de una paciente joven de 24 años, multigestante, con embarazo pobremente controlado, quien acude al servicio de urgencias de un hospital de III nivel de complejidad de la ciudad de Barranquilla, Atlántico, Colombia con cuadro clínico de dolor abdominal. Posterior a rastreo ecográfico realizado en el servicio y con evidencia de anhidramnios, es realizada cesárea de urgencia con hallazgo de embarazo abdominal con producto vivo a término. La madre es llevada a unidad de cuidados intensivos con evolución satisfactoria y dada de alta junto al recién nacido. Se pre-senta una revisión de la epidemiología, cuadro clínico y manejo

In this article a case and a review of the literature about abdominal pregnancy are reported. The patient was a young multiparous woman with a poorly controlled pregnancy who arrived to emergency room with abdominal pain, which began three days ago, later was perform an ultrasonographic examination that revealed oligohydram-nios. Was performed an emergency cesarean section with abdominal pregnancy and finding a live and term fetus. Mother was followed in intensive care unit with a satisfactory postoperative evolution. Mother and child were discharged a few days later. We discuss the epidemiology, clinical manifestations and management.

Secondary abdominal pregnancy in human immunodeficiency virus-positive woman

We report on an abdominal pregnancy in human immunodeficiency virus-positive mother, currently on antiretroviral therapy, which was discovered incidentally while training the obstetric ultrasound capacity building program. Although abdominal pregnancy is a rare form of ectopic pregnancy, it may be more common in women with HIV infection because they tend to have a higher rate of sexually transmitted diseases than the general population. The positive diagnosis of abdominal pregnancy is difficult to establish and is usually missed during prenatal assessment particularly in settings that lack routine ultrasound examination as is the case in most developing countries. For the management of abdominal pregnancy, surgical intervention is recommended and removal of the placenta is a key controversy. Ultrasonography is considered the front-line and most effective imaging method and an awareness with a high index of suspicion of abdominal pregnancy is vital for reducing associated high maternal and even higher perinatal mortality.

Embarazo ectópico abdominal / Abdominal ectopic pregnancy

El embarazo ectópico abdominal ocurre con escasa frecuencia. Se refiere al implante del embarazo en algunas de las estructuras de la cavidad abdominal, generalmente se asocia a una alta incidencia en la mortalidad materna y fetal; la mortalidad materna es siete veces mayor que en el embarazo tubárico y hasta 90 veces más que en el embarazo normal. El caso que a continuación se presenta es una paciente con antecedentes de salud previa, que asistió al Hospital Provincial de Bengo, municipio de Dande de la República Popular de Angola, en septiembre de 2013. Se le diagnosticó un embarazo a término con una deficiente atención prenatal. Se detectó perdida genital y ausencia de latidos cardiacos fetales. Se le comenzó la inducción del parto, y al no tener progreso, se realizó la cesaría hallándose un embarazo ectópico abdominal. Se realizó la extracción de un recién nacido a término muerto y gran parte de la placenta.

Abdominal ectopic pregnancy is not frequent. It refers to the extrauterine implantation of pregnancy in some of the abdominal cavity structures, generally associated with a high incidence of maternal and fetal mortality; rates of maternal mortality have been reported as high as sevenfold higher than in tubal pregnancy, and up to ninetyfold higher than normal pregnancy. This case report (September 2013) presents a patient with previous history, she attended to Bengo Provincial Hospital, Dandede municipality, People’s Angola Republic. The pregnancy was detected at term with poor prenatal care. Genital loss and absence of fetal heartbeats were observed. The Induction of labor was initiated, having not progress; a cesarean section was performed, finding an abdominal ectopic pregnancy. The removal of a stillborn at term and great part of the placenta was performed.