RESUMEN
@#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.
Asunto(s)
Embarazo EctópicoRESUMEN
Advanced abdominal pregnancy (AAP) with a viable full-term fetus is a rarity that a few obstetricians encounter during their professional carrier. Usually it has a dramatic and catastrophic consequence both for the fetus & the mother; rather subsequent delivery of a viable full term fetus is exceptional. It is difficult to diagnose preoperatively. Though relatively rare, we received an AAP at term with live fetus in Faridpur Medical College & hospital. Illiteracy, poverty and lack of antenatal care had resulted in her late presentation. After laparotomy the diagnosis was confirmed, a healthy male baby was delivered.
RESUMEN
Advanced abdominal pregnancy is understood to mean any extrauterine pregnancy found within the peritoneal cavity that is greater than 20 weeks gestation. Its management is one of laparotomy with varying complications including poor perinatal outcome and increased maternal morbidity and mortality. There is no accepted consensus for the complete removal of the placenta at laparotomy. This paper reports the management of a unique case of advanced abdominal pregnancy that was diagnosed by ultrasound at 20 weeks gestation and treated conservatively until delivery of a viable female neonate at 33 weeks and 4 days by elective laparotomy. At the time of laparotomy, the placenta was removed completely with good maternal outcome. This, to the best of our knowledge, is the first case in the West Indian literature documenting complete removal of the placenta at the time of laparotomy with good maternal outcome.
Por embarazo abdominal avanzado se entiende cualquier embarazo extrauterino que se halle dentro de la cavidad peritoneal, a partir de las 20 semanas de gestación. Su tratamiento requiere laparotomía, y presenta distintas complicaciones que incluyen pobre resultado perinatal, así como aumento de la morbilidad y mortalidad materna. No hay consenso con respecto a la extracción completa de la placenta al realizar la laparotomía. Este trabajo reporta el tratamiento de un único caso de embarazo abdominal avanzado, diagnosticado por ultrasonido a las 20 semanas de gestación, y tratado de forma conservadora hasta el parto de un neonato viable hembra a las 33 semanas y cuatro días, mediante laparotomía electiva. A la hora de la laparotomía, se extrajo la placenta completamente con un buen resultado materno. Se trata - hasta donde sabemos - del primer en la literatura de West Indies, que documenta la extracción completa de la placenta al momento de la laparotomía con buen resultado materno.