Diagnostic Challenges of an Abdominal Pregnancy in the Second Trimester

Ranaei-Zamani, Niccole; Palamarchuk, Tetyana; Kapoor, Swena; Kaler, Mandeep; Atueyi, Favour; Allen, Ruth

doi:10.1155/2021/7887213

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…Secondary intra-abdominal pregnancy is more common and is often the result of peritoneal implantation following rupture of the fallopian tube, ovary, or intrauterine pregnancy. [5,7] In the present case, the patient uterus was intact during the operation, the left adnexa appeared normal, and the normal anatomical structure of the right adnexa was unclear. The postoperative pathology showed that the placental fetal surface had the umbrella end of the fallopian tube, which was considered to happen after the fallopian tube rupture.…”

Section: Discussionmentioning

confidence: 62%

“…It is an extremely rare type of ectopic pregnancy, with an incidence rate of 1:10000 to 1:30000, accounting for 0.6% of all ectopic pregnancies. [ 2 , 5 ] Most abdominal pregnancies originate from ruptured tubal pregnancies, and in some cases, the implantation occurs directly on the uterine serosa, omentum, intestine, and mesentery, thereby increasing the risk of fatal intra-abdominal hemorrhage. [ 6 ] Reportedly, the maternal mortality rate of abdominal pregnancy is approximately 7.7 times that of tubal pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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A case report of dangerous pelvic infundibulum ligament in the second trimester of pregnancy with massive hemorrhage

Dai,

Chen,

et al. 2023

Medicine

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Rationale: Abdominal pregnancy is a rare ectopic pregnancy and its diagnosis and treatment are more challenging than those of other ectopic pregnancies. Because of a variable pregnancy site, abdominal pregnancy is associated with an increased risk of fatal abdominal hemorrhage, and consequently, an increased risk of maternal death compared with intrauterine pregnancy. Diagnoses: Pelvic infundibulum ligament pregnancy complicated with massive hemorrhage. Patient concerns: 42-year-old pregnant woman who did not undergo an obstetric examination during the first trimester presented with sudden abdominal pain during the second trimester. Abdominal pregnancy was confirmed after emergency treatment, causing difficulty in the comprehensive preoperative evaluation. Interventions: In order to save the patient life, we actively carried out surgical treatment. Outcomes: The patient recovered well after the operation and was discharged on the 11th postoperative day. Blood β-human chorionic gonadotropin (β-hCG) levels and routine blood test results were normal 1 month after the surgery, and the patient had recovered. Lessons: Several challenges are encountered in the diagnosis of abdominal pregnancy with regard to insufficient economic, cultural, and medical resources. In case of ectopic pregnancies, surgery should be the first choice of treatment, and preparations of blood transfusion are essential to combat the risk of rapid hemorrhagic shock caused by placenta implantation in the infundibulum ligament of the pelvis. The operation must be performed by experienced obstetricians and gynecologists.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

A case report of dangerous pelvic infundibulum ligament in the second trimester of pregnancy with massive hemorrhage

Dai,

Chen,

et al. 2023

Medicine

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“…To reduce this limitation, use of criteria such as; (1) demonstration of a foetus in a gestational sac outside the uterus; (2) failure to visualize the uterine wall between the foetus and urinary bladder; (3) proximity between the foetus and the anterior abdominal wall; and (4) localization of the placenta outside the confines of the uterine cavity has been proposed [ 16 ]. More advanced diagnostic modalities such as magnetic resonance imaging provides superior outcome compared to ultrasound scans [ 17 ] but are rarely available in resource limited-setting.…”

Section: Discussionmentioning

confidence: 99%

Chronicles of an uncommon term abdominal pregnancy with successful outcome: a case report

Magezi,

Wacha,

Pebalo

2024

J Med Case Reports

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Background Intra-abdominal pregnancies, while rare, present with unique diagnostic and management challenges. We present a case of a 25-year-old para 2 + 1, black African woman, who was referred from a peripheral Health Centre level IV in the Northern part of Uganda to a Regional Referral Hospital due to an abnormal presentation with easily palpable fetal parts. This case emphasizes the significance of prompt diagnosis, interdisciplinary collaboration, surgical planning, and managing the placenta in advanced intra-abdominal pregnancies. Case presentation A 25 year African black female, para 2 + 1 upon arrival at Regional Referral Hospital, a University Teaching Hospital during a weekend, an ultrasound was sourced from a nearby private clinic revealing an extra-uterine intra-abdominal pregnancy at 38 weeks of gestation and she was promptly sent back to the University Teaching Hospital. Following this diagnosis, the patient, who hailed from a remote village over 30 km away, returned to her family for discussions. After three days, she was readmitted. Emergency laparotomy unveiled an omental gestation sac with extensive placental attachment. A live female infant was delivered successfully, placenta was left in situ. The postoperative course was uneventful, with initial concerns about inadequate breast milk flow which resolved after placental removal during the second exploratory laparotomy. Conclusion This case highlights the uncommon occurrence of an advanced intra-abdominal pregnancies and emphasizes the importance of multi-disciplinary teamwork and placental management. The favorable outcome in the management was based on thorough assessment of the placental location, attachments and blood supply during surgery. It demonstrates the possibility of reduced risk of massive bleeding if there is a delayed removal of placenta with favorable attachment. This is particularly important for milk letdown as well as reducing the needs of blood transfusion in resource limited settings.

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“…The diagnosis of late abdominal pregnancy was missed. The diagnosis of abdominal pregnancy in the second and third trimester is difficult and can be missed up to 50% of the time, despite regular antenatal care and imaging [11,17]. Chen et al published a case report of abdominal pregnancy and review of 17 other cases, and reported that only 5 out of 17 cases were diagnosed before surgery [9].…”

Section: Discussionmentioning

confidence: 99%

Challenging Diagnosis of Late Abdominal Pregnancy: A Case Study of Misdiagnosis and Fetal Death in the Third Trimester

Alwafai,

Kolbe,

Kruse-Wieczorek

et al. 2024

Am J Case Rep

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Patient: Female, 34-year-old Final Diagnosis: Abdominal pregnancy • ectopic pregnancy Symptoms: Abdominal pain Clinical Procedure: — Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: Abdominal pregnancy is a rare form of extrauterine pregnancy that usually results in a poor outcome; it is associated with serious fetal and maternal morbidity. The diagnosis of advanced abdominal pregnancy is sometimes challenging and should be identified early, at a routine antenatal examination. There are still no evidence-based management strategies for late abdominal pregnancy. This report presents a case of a patient with an abdominal pregnancy and a non-viable fetus. Case Report: A 34-year-old woman presented as an emergency 2 months after the diagnosis of intrauterine fetal death at 33 weeks of gestation. During subsequent surgery, the pregnancy was found to be an undiagnosed abdominal pregnancy. The patient had been admitted due to abdominal pain and increasingly deteriorating general condition. On admission, clinical examination and abdominal ultrasound were carried out and the diagnosis of fetal death was confirmed. The diagnosis of extrauterine pregnancy, however, was initially missed, and a decision to induce labor was made. After unsuccessful induction of labor and deterioration of the patient’s general condition, a laparotomy was performed, and the diagnosis of abdominal pregnancy was confirmed. A severely macerated fetus and placenta were delivered. Relative to others with this condition, the patient had a very good postoperative outcome with prolonged healing of the surgical incision. Informed consent for publication was obtained from the patient. Conclusions: The diagnosis of late abdominal pregnancy can be missed despite clinical and sonographic examination. This diagnosis should be considered and excluded in similar suspected clinical findings. Proper operative planning in a tertiary center with a well-experienced team is crucial.

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Diagnostic Challenges of an Abdominal Pregnancy in the Second Trimester

Cited by 4 publications

References 9 publications

A case report of dangerous pelvic infundibulum ligament in the second trimester of pregnancy with massive hemorrhage

A case report of dangerous pelvic infundibulum ligament in the second trimester of pregnancy with massive hemorrhage

Chronicles of an uncommon term abdominal pregnancy with successful outcome: a case report

Challenging Diagnosis of Late Abdominal Pregnancy: A Case Study of Misdiagnosis and Fetal Death in the Third Trimester

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