Embarazo ectópico abdominal con feto vivo en el Hospital Provincial de Bié, Angola / Abdominal ectopic pregnancy with a live fetus in Bié Provincial Hospital, Angola

El embrión, en condiciones normales, es concebido en la trompa y migra al útero. Un pequeño porcentaje que no llega a completar esta migración, se convierte en embarazo ectópico. Se presentó el caso de un embarazo ectópico abdominal con feto vivo; paciente femenina de 32 años de edad, multigesta con 4 partos eutócicos a término. A las 37 semanas de edad gestacional se remitió al Hospital Provincial de Bié por presentar dolor abdominal difuso, de moderada intensidad, que se exacerbaba con los movimientos fetales. Se realizó la cesárea, se encontró un embarazo ectópico abdominal con feto vivo y placenta implantada en fondo uterino, epiplón y colon transverso. Se dejó placenta in situ para un posterior seguimiento.

The embryo, under normal conditions, is conceived into the fallopian tube and migrates to the uterus. A small percentage of the embryos that do not complete this migration become an ectopic pregnancy. We present a 32-year-old female patient with multiple gestation pregnancies and 4 normal term deliveries who had an abdominal ectopic pregnancy with a live fetus. She was referred to Bié Provincial Hospital at 37 weeks' gestation due to diffuse abdominal pain of moderate intensity, which was exacerbated by fetal movements. A cesarean section was performed; an abdominal ectopic pregnancy with a live fetus and the placenta implanted in the uterine fundus, omentum, and transverse colon was found. The placenta was left in situ for further follow-up.

Prevalencia de depresión en el embarazo y puerperio. Diferencia entre multíparas y primigestas / Prevalence of depression in pregnancy and puerperium. Difference between multiparous and primigravidae

Objetivo: Analizar la prevalencia de depresión en el embarazo y puerperio, diferencia entre multíparas y primigestas atendidas en el hospital del IESS Riobamba en el periodo junio-diciembre 2018. Método: Estudio clínico de carácter descriptivo e investigativo en campo utilizando la escala de Edimburgo. Resultados: Los puerperios en 43% respondieron a una prevalencia hacia la depresión. Conclusión: La depresión resulta ser uno de los factores más complejos actualmente. De ser factible, para tratar casos de esta índole resulta ser necesaria la presencia total de los especialistas como el obstetra, el pediatra, e incluso el médico general, especialistas que estén completamente familiarizados en el área de la depresión durante el periodo fetal, debido a que una intervención temprana puede convertirse en un punto clave para un diagnóstico previo de cómo actúa este tipo de afecciones en las mujeres embarazadas.

Objective: To analyze the prevalence of depression in pregnancy and puerperium, difference between multiparous and primigravidae attended at the IESS Riobamba hospital in the period June-December 2018. Method: Descriptive and investigative clinical study in the field using the Edinburgh scale. Results: 43% of postpartum patients had a prevalence of depression. Conclusion: Depression turns out to be one of the most complex factors at present. If it is feasible, to treat cases of this nature it turns out to be necessary the total presence of specialists such as the obstetrician, the pediatrician, and even the general practitioner, specialists who are completely familiar in the area of depression during the fetal period, due to the fact that an early intervention can become a key point for a previous diagnosis of how this type of conditions acts in pregnant women.

Ultrasonographic diagnosis and misdiagnosis of hepatic pregnancy / 中国医师杂志

Objective:To investigate the ultrasonographic characteristics and misdiagnosis of hepatic pregnancy.Methods:The clinical data and preoperative ultrasound characteristics of 2 cases of hepatic pregnancy admitted to the Affiliated Hospital of Jining Medical College were retrospectively summarized, and related literatures were retrieved from January 1, 1956 to December 31, 2021.Results:A total of 37 cases of hepatic pregnancy were included, among which 35 cases showed liver nodules on ultrasound examination, which were classified into four types: pregnancy cystic (24 cases), thick-walled cystic echo (6 cases), heterogeneous hyperecho (3 cases) and mixed cyst solid echo (2 cases), the exact diagnosis coincidence rate of each type was 100%, 4/6, 1/3, 0, respectively. Among the 35 liver nodules, 29(82.8%) cases were diagnosed correctly by ultrasound, 1 case was misdiagnosed as choriocarcinoma liver metastasis, 1 case was misdiagnosed as hepatic hemangioma, and 4 cases were diagnosed as liver nodules without suggestive diagnosis. No liver nodules were found in the other 2 cases, including 1 case misdiagnosed as retroperitoneal hematoma and 1 case misdiagnosed as ruptured ovarian cyst.Conclusions:Ultrasonography of hepatic pregnancy may show pregnancy sac, thick-walled cystic echo, hyperecho and mixed echo in liver. The first type is easy to be diagnosed accurately by ultrasound, while the other types are easy to be misdiagnosed. Combined with clinical conditions and the result of enhanced computed tomography (CT), the correct diagnosis rate of hepatic pregnancy can be improved.

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 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)

Embarazo ectópico abdominal a término con feto vivo en mujer angolana adulta joven / Term ectopic abdominal pregnancy with live fetus in young adult Angolan woman

RESUMEN Introducción: el embarazo ectópico abdominal es una anomalía excepcional que representa el 1 % de los embarazos ectópicos; se asocia con alta morbilidad y mortalidad materna y fetal. El riesgo de mortalidad materna es de siete a ocho veces mayor que el de un embarazo ectópico tubario y 90 veces mayor que el de un embarazo intrauterino. Presentación del caso: paciente angolana adulta joven con un embarazo ectópico abdominal diagnosticado al término del embarazo. Se trató con éxito mediante cesárea con extracción del feto vivo y sin complicaciones. No se extrajo la placenta por encontrarse implantada al Meso intestinal y se aplicó tratamiento con metrotexate posterior a la intervención quirúrgica. Conclusiones: el embarazo abdominal es una enfermedad de difícil diagnóstico a pesar de los avances tecnológicos. Por lo que el sistema de salud debe establecer estrategias y programas educativos accesibles, dirigidos a la población femenina que tengan sospecha de embarazo ectópico. Una vez diagnosticado el embarazo abdominal, debe interrumpirse, a menos que la edad de gestación sea avanzada. El manejo de la placenta debe ser individualizado.

ABSTRACT Introduction: abdominal ectopic pregnancy is an exceptional abnormality representing 1% of ectopic pregnancies; it is associated with high maternal and fetal morbidity and mortality. The risk of maternal mortality is seven to eight times greater than a tubal ectopic pregnancy and 90 times greater than an intrauterine pregnancy. Case report: young adult Angolan patient with an ectopic abdominal pregnancy diagnosed at the end of pregnancy; successfully treated by caesarean section with live, uncomplicated extraction of the fetus. Removal of the placenta was not attempted as it was implanted in the mesointestinal structure; undergoing treatment with methotrexate after the surgery. Conclusions: abdominal pregnancy is a complex disease to be diagnosed despite technological advances. Therefore, the health system must establish accessible educational strategies and programs aimed at taking care of female population suspected of ectopic pregnancy. Once an abdominal pregnancy has been diagnosed, it should be interrupted, except the gestational age is advanced. The management of the placenta should be individualized.

Embarazo ectópico abdominal: protocolo de tratamiento combinado. Reporte de un caso / Ectopic abdominal pregnancy: combined treatment strategy: A case report

Resumen ANTECEDENTES: El embarazo ectópico abdominal es una alteración poco frecuente, sin tratamiento definido hasta ahora. La extracción quirúrgica del feto y la aplicación de metotrexato representan una opción de tratamiento en pacientes con embarazo ectópico abdominal. CASO CLÍNICO: Paciente de 36 años, con 16.2 semanas de embarazo, que acudió al servicio de urgencias por un cuadro de dolor en el epigastrio. El ultrasonido pélvico y la tomografía computada evidenciaron una imagen sugerente de feto sin vitalidad en el hipocondrio derecho. La laparotomía exploradora objetivó un feto masculino, de 115 g, cubierto con epiplón en el mesogastrio, extraído sin dificultad. No se retiró el tejido placentario, pues se encontraba adherido al tejido intestinal. El tratamiento consistió en múltiples dosis de metotrexato. La paciente evolucionó satisfactoriamente y fue dada de alta sin complicaciones. CONCLUSIÓN: El tratamiento combinado (laparotomía para la extracción del feto y administración posterior de metotrexato) es una opción efectiva en pacientes con embarazo ectópico abdominal no complicado, con tejido placentario adherido en zonas sumamente vascularizadas.

Abstract BACKGROUND: Abdominal ectopic pregnancy is a rare entity which treatment has not been clearly stablished. One of the therapeutic alternatives is the surgical extraction of the fetus and the subsequent application of methotrexate in these patients. CLINICAL CASE: A 36-year-old female patient came to the emergency unit complaining of pain in the epigastrium. The patient referred a pregnancy of 16.2 weeks. Pelvic ultrasound and computed tomography were performed, demonstrating a suggestive image of a fetus without vitality at the level of the right hypochondrium. An exploratory laparotomy was performed. A male 115 gram fetus was observed at the level of mesogastrium, and was extracted without difficulty. Placental tissue was not removed because it was adhered to intestinal tissue. The subsequent management consisted of methotrexate. The patient was discharged without complications. CONCLUSION: The combined therapy between laparotomy for the extraction of the fetus and administration of methotrexate may be viable for cases of uncomplicated abdominal ectopic pregnancy in which the placental tissue is adhered to highly vascularized areas.

MRI diagnosis of abdominal pregnancy / 中国医学影像技术

Objective To observe the application value of MRI in diagnosis and clinical management of abdominal pregnancy.Methods MRI and clinical data of 5 patients with abdominal pregnancy proved surgically were analyzed retrospectively.MRI performances were analyzed and compared with findings in operation.Results Prenatal MRI correctly diagnosed abdominal pregnancy in all 5 patients,including 1 case of primary and 4 cases of secondary abdominal pregnancy.The position of uterine rupture was revealed in all 4 cases of secondary abdominal pregnancy.MRI performances of placenta conformed to operative findings in all 5 patients.A lot of fresh intra-abdominal hemorrhage was found in 1 case,oligohydramnion in 2 cases,and abnormalities of placenta and fetus in 2 patients,which were consistent with findings of operation.Conclusion Prenatal MRI offers a high accuracy rate in diagnosis of abdominal pregnancy.MRI can show fetus,placenta and the relationship with surrounding tissue,therefore being helpful to clinical management of abdominal pregnancy.

Cesárea en paciente con trombosis portal crónica y trombocitopenia: reporte de caso / Caesarean section in a patient with chronic portal vein thrombosis and thrombocytopenia: Case report

Abstract We report the case of a pregnant woman at term with primary anti-phospholipid syndrome, portal vein thrombosis, massive splenomegaly, oesophageal varices and thrombocytopenia. The patient underwent an elective caesarean section under general anaesthesia to minimise the risk of spleen and variceal rupture, with a favourable outcome for both the mother and the newborn. Chronic portal vein thrombosis is a rare condition, caused by various reasons, mainly thrombotic diathesis. It leads to increased portal pressure, with development of collateral circulation, splenomegaly and thrombocytopenia. Pregnancy in these conditions is considered high risk, but is not contraindicated if the underlying disorder is stabilised. The management of these patients should be multidisciplinary, under close monitoring; diagnosis and treatment of possible oesophageal varices is essential. The decision about mode of delivery and anaesthetic management must be individualised, depending on obstetric factors, the presence or absence of varices and thrombocytopenia, and associated comorbidities.

Resumen Presentamos el caso de una gestante a término con síndrome antifosfolípido primario, trombosis portal crónica, esplenomegalia masiva, varices esofágicas y trombocitopenia. La paciente fue intervenida mediante una cesárea electiva bajo anestesia general para minimizar el riesgo de rotura del bazo y de las varices, con un resultado favorable para la madre y el neonato. La trombosis portal crónica es una entidad poco frecuente, motivada por distintas causas, principalmente las diátesis trombóticas. Induce un aumento de la presión portal, con desarrollo de circulación colateral, esplenomegalia y trombocitopenia. La gestación en estas condiciones se considera de alto riesgo, pero no está contraindicada si la enfermedad está estabilizada. El manejo de estas pacientes debe ser multidisciplinar y su seguimiento, estrecho; el diagnóstico y tratamiento de las posibles varices esofágicas es esencial. La decisión sobre el modo de finalizar la gestación y el manejo anestésico deben individualizarse en cada caso, en función de factores obstétricos, de la presencia o no de varices y trombocitopenia, y de las comorbilidades asociadas.

Embarazo ectópico abdominal, presentación de un caso y revisión de la literatura / Abdominal ectopic pregnancy: case report and literature review

ANECEDENTES El embarazo ectópico abdominal es raro; con baja incidencia y ausencia de sintomatología especifica que dificulta el diagnóstico y no existan criterios para el diagnóstico y tratamiento. OBJETIVO se presenta un caso de embarazo intra-ligamentario de 16 semanas de gestación y se hacer una revisión de la literatura sobre el manejo y comparación de los resultados. CASO CLÍNICO Mujer de 32 años de edad, gestas 3 partos 2; desconoce fecha de ultima menstruación; y control de la fertilidad con condón; acude por presentar dolor abdominal, sin datos de irritación peritoneal; se le realiza ultrasonido y se diagnostica embarazo de 16 semanas con muerte fetal; con sospecha embarazo abdominal; se realiza laparotomía exploradora para extracción fetal, dejando la placenta in situ, y manejo con metotrexate dejando la placenta in situ y egresado al tercer día sin complicaciones. CONCLUSIÓN el embarazo abdominal es raro, de difícil diagnostico; que requiere la extracción quirúrgica y dejar la placenta in situ y manejo adyuvante con metrotexate; reportándose buenos resultados; pero, existe escasa información sobre la fertilidad futura.

BACKGROUND The abdominal ectopic pregnancy is rare; with low incidence and absence of specific symptomatology diagnosis difficult and there are no criteria for the diagnosis and treatment. OBJECTIVE a case of intra-ligament 16 weeks of gestation pregnancy occurs and a review of literature on the handling and comparison of results is done. CASE REPORT Female 32 years old, deeds 3 births 2; known last menstrual period; and fertility control with a condom; comes because of abdominal pain without peritoneal irritation; Ultrasound was performed 16 weeks pregnant and diagnosed with fetal death; abdominal suspected pregnancy; laparotomy for fetal extraction is performed, leaving the placenta in situ, and leaving management methotrexate placental site and discharged on the third day uncomplicated. CONCLUSION abdominal pregnancy is rare, difficult to diagnose; requiring surgical removal and leave the spot and adjuvant use with methotrexate placenta; good results being reported; but there is little information on future fertility.

Successful laparoscopic management of uterine serosal pregnancy

Uterine serosal pregnancy is an extremely rare form of ectopic pregnancy. This is a report of a 35-year-old primigravida woman who was diagnosed with uterine serosal pregnancy via laparoscopic intervention. A 35-year-old woman (gravida 1, para 0) was referred from a local clinic for a ruptured left tubal pregnancy at amenorrhea 5+0 weeks with elevated serum beta human chorionic gonadotropin (16,618 mIU/mL). A pregnancy on the left posterior wall of the uterine serosa was diagnosed during the operation and successfully treated with laparoscopic surgery as a conservative management strategy to enable fertility preservation. With the advantages of ultrasonography and laparoscopy, an early diagnosis of a primary abdominal pregnancy located on the left posterior wall of the uterine serosa was made, prior to the occurrence of severe intra-abdominal massive hemorrhage, which was then treated laparoscopically as a conservative management strategy enabling the preservation of fertility.

Informe de caso sobre cardiomiopatia periparto: rara, desconocida y potencialmente fatal / Peripartum cardiomyopathy - Rare, unknown and life-threatening

Objectives: To present a clinical case and to conduct a non-systematic review of the literature on peripartum cardiomyopathy, and to describe its incidence, aetiology and pathophysiology. Material and methods: With the authorization of the Ethics Committee of our institution, we present the case of a patient of mestizo ethnic origin who developed asthenia, adynamia, lower limb asymmetrical pain and functional class deterioration during the post-partum period, and her management in the Intensive Care Unit and final outcome. The search of the literature was conducted in PubMed, Scielo and Bireme. Results: Peripartum cardiomyopathy is associated with significant morbidity and mortality. The clinical course varies between progressive improvement, heart failure, transplant or death. Some national reports were found. Conclusions: Peripartum cardiomyopathy affects a young and healthy population during a period of time ranging between the end of pregnancy and five months postpartum. The aetiology and pathogenesis are unknown, but several hypotheses have been proposed: viral myocarditis, autoimmune and/or abnormal haemodynamic response to the pregnancy, genetic susceptibility, malnutrition, and apoptosis. The prognosis of recovery of left ventricular function (LVEF) depends on early detection within seven days of the onset of symptoms, an initial LVEF greater than 30%, and a left ventricular diastolic diameter (LVDD) smaller than 60 mm. Mortality is associated with parity greater than four, older age and black ethnc background (6.4 times higher than in Caucasians).

Objetivos: Presentación de un caso clínico y revisión no sistemática de la literatura sobre cardiomiopatia periparto, describir su incidencia, etiología y fisiopatología. Material y métodos: Con autorización del comité de Ética de nuestra institución, se presenta el caso de una paciente de origen étnico mestizo que durante su puerperio consulta por astenia, adinamia, asimetría en miembros inferiores acompañado de deterioro de clase funcional. Su posterior manejo en Unidad de Cuidados Intensivos y desenlace. La búsqueda bibliográfica se realizó en PubMed, Scielo y Bireme. Resultados: La cardiomiopatia periparto es una enfermedad con una importante morbimortalidad. Su curso clínico varía entre una mejoría progresiva, falla cardiaca, trasplante o muerte. Encontramos algunos reportes a nivel nacional. Conclusiones: La cardiomiopatia periparto afecta a una población joven y sana, desde el final del embarazo y hasta cinco meses postparto. Su etiología y patogénesis son desconocidas, las hipótesis propuestas son: la miocarditis viral, una respuesta autoinmune y/o hemodinámica anormal al embarazo, susceptibilidad genética, desnutrición, y la apoptosis. La recuperación de la fracciones de eyección del ventrículo izquierdo (FEVI) depende de: una detección temprana menor a siete días desde el inicio de los síntomas, la FEVI inicial mayor a 30% y diámetro ventricular izquierdo diastólico menor a 60 mm. La mortalidad está asociada con la paridad mayor de cuatro, la edad avanzada y origen étnico negro que es 6,4 veces mayor comparados con las caucásicas.

Embarazo abdominal calcificado de 40 años de evolución, hallazgo incidental: Presentación de caso / Calcified Abdominal Pregnancy 40 Years of Evolution, Incidental Finding: a Case Report

Debido a la baja incidencia de embarazos ectópicos abdominales y, más aún, de la formación de litopedion, se reporta el caso de una paciente de 84 años quien consulta por cuadro clínico de colelitiasis y pancreatitis de origen biliar, con hallazgo incidental de litopedion en cavidad abdominal de más de 40 años, documentado y diagnosticado por medio de radiografía convencional de abdomen y confirmado con tomografía computarizada multidetector (TCMD). Se realizó una revisión de la literatura mundial sobre los aspectos clínicos, radiológicos y patológicos del embarazo abdominal con presentación de litopedion

Due to the low incidence of abdominal ectopic pregnancy and, even more, of the formation of lithopedion, the case of an 84-years-old female patient is presented, who was admitted with clinical symptoms of cholelithiasis and biliary pancreatitis, with an incidental finding of lithopedion in the abdominal cavity, of more than 40 years. It was documented and diagnosed using conventional abdominal radiography, and confirmed with multidetector computed tomography (MDCT). The article presents a review of world literature on the clinical, radiological and pathological features of abdominal pregnancy with lithopedion.

Manejo anestésico en cesárea de una gestante con esclerosis múltiple: Reporte de un caso y revisión de la literatura / Management of anesthesia during C-section of a multiple sclerosis pregnant woman: Case report and literature review

Case description of a pregnant woman at term with a history of Multiple Sclerosis, scheduled for C-section and with a diagnosis of fetal macrosomia; the patient had undergone a C-section in the past during pro-dromal labor. The physical examination showed no motor or sensory deficit. The CBC showed anemia and mild lymphocytosis. The patient underwent cesarean section under single-dose epidural anesthesia with no complications and favorable evolution. Multiple sclerosis is a rare neurological condition, even rarer in pregnant women undergoing C-section. So a literature search was undertaken aimed at improving the management of anesthesia in this group of patients.

Se describe el caso de una gestante a término de 26 años con antecedente de Esclerosis Múltiple programada a cesárea con diagnóstico de macrosomía fetal y cesareada anterior una vez, en pródromos de trabajo de parto. Al examen físico no déficit motor ni sensitivo. Hemograma anemia y linfocitosis leve. La paciente fue sometida a cesárea con anestesia epidural dosis única sin complicaciones y con evolución favorable. La esclerosis múltiple es una enfermedad neurológica poco frecuente y aún menos frecuente en gestantes con esclerosis múltiple sometida a cesárea por lo que se realizó una búsqueda de la literatura para un mejor manejo anestésico de este grupo de pacientes.

Clinical analysis of abdominal pregnancy / 中国基层医药

Objective To investigate the clinical features,diagnosis and treatment of abdominal pregnancy.Methods The clinical data of 2 cases with abdominal pregnancy at the hospital of Guinea Ecuatorial de Bata from June 2000 to June 2002 were reviewed.Results 2 cases were secondary abdominal pregnancy.The main clinical symptoms were abdominal pain and vaginal bleeding when early pregnancy,on case was living infant.The cases were treated by surgery and fully recover.Conclusion Abdominal pregnancy causes heavy acute abdomen pain.It is difficult for diagnosis in the early period at primary hospital.To master its clinical features and to operate immediately once the diagnosis is made will be exclusive treatment principle.

Old Abdominal Pregnancy Presenting as an Ovarian Neoplasm

Abdominal pregnancy is extremely rare, but even more unusual is the prolonged retention of an advanced abdominal pregnancy with lithopedion formation. The presentation of lithopedion as an ovarian tumor without a symptom has not been reported in Korea. A 63-yr-old, gravida 2, para 1, woman was referred to us with an abominal mass. Pelvic examination revealed normal postmenopaused uterus and a fetal head-sized movable hard mass in the lower abdomen. The computed tomographic scan showed a densely echogenic mass of 10-cm in diameter as an ovarian neoplasm. Laparotomy disclosed a lithopedion, of which the bones and cartilages were well preserved. There have been controversies on the treatment of lithopedion. Although some cases are stable for a long time, the morbidity increases when the operation is performed in an elderly patient. So we believe that the surgical intervention should be done as soon as possible after thorough consideration of the morbidity and the risk.

Embarazo abdominal con recién nacido y madre vivos. Presentación de un caso / Abdominal pregnancy with newborn and mother alive . Case presentation

El embarazo ectópico de localización abdominal es una entidad rara que constituye menos del 4% de los embarazos ectópicos, pero que se acompaña de una elevada morbimortalidad. Reportamos un caso de embarazo abdominal ocurrido en nuestra provincia en 1999 que tuvo una evaluación satisfactoria, donde no fue posible realizar el diagnóstico precoz durante la atención prenatal. Después de una laparotomía de urgencia a las 35 semanas de gestación, motivada por una preclampsia grave, se extrajo un recién nacido vivo, masculino de 2060 gr con Apgar 8/9, que presentó asimetría facial, pie varo equino congénito derecho y neumonía congéntia. Madre e hijo sobrevivieron y se encuentran en buen estado de salud.

Ectopic pregnancy with abdominal localization is a rare entity that covers lower than 4% of the ectopic pregnancies, but it is accompanied by high morbymortality. We report a case of abdominal pregnancy occurred in our province in 1999 with a satisfactory evaluation in which it was not possible to care. After urgent laparotomy at 35 weeks of gestation, motivated by a severe preclampsia, an alive newborn, masculine of 2060 gr with Apgar 8/9 was extracted, who presented facial asymetry, congenital pie equinovarus and congenital pneumonia. The mother and her son survived and are is goog health state.