Experience of Secondary Abdominal Pregnancy Reported at a Rural Tertiary Care Center of Western India: A Case Series.

Abdominal pregnancy remains a rare entity among ectopic pregnancies overall; however, it carries the highest risk of mortality and morbidity for the mother and the fetus. Prompt diagnosis and early intervention remain the main modality of treatment to prevent catastrophic complications because of abdominal pregnancy. However, many barriers exist, leading to delayed diagnosis and management. We present three cases of secondary abdominal pregnancy with different outcomes over three years from 2018 to 2021. The clinical presentation, evaluation, management plan, and outcomes of the cases are discussed separately.

Expectant management of advanced abdominal pregnancies: Is it justifiable?

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.

Histopathological features in advanced abdominal pregnancies co-infected with SARS-CoV-2 and HIV-1 infections: A case evaluation.

Objectives: This study aims to provide a semi-qualitative histopathological report of the dual SARS-CoV-2 and HIV infected placentae in the third trimester of Advanced Abdominal Pregnancy (AAP). Study design: Four AAP placentae in the third trimester of pregnancy (two positive for HIV-1 and two positives for SARS-CoV-2) were histologically examined. Results: The SARS-CoV-2+ HIV+ placentae were dysmorphic in shape compared to the flattened disc-like shape noted in the SARS-CoV-2+HIV-, SARS-CoV-2-HIV+and SARS-CoV-2-HIV- placentae. Diffused syncytial knots and syncytial degeneration were observed in all placentae. Intermittent cytotrophoblast increase, perivillous and intravillous fibrin deposition, mononuclear inflammatory cells with widespread degeneration/necrosis of the syncytiotrophoblast and microcalcification were pronounced in the SARS-CoV-2+HIV+ compared to the SARS-CoV-2+HIV- placentae. Vascular pathological changes included thrombi, ectasis, mural hypertrophy and atherotic vessels. Conclusion: Elevated syncytial trophoblast injury, villitis, microcalcifications and mineralisation of the syncytial basement membrane in the AAP placentae may be due to SARS-CoV-2 viral transgression instead of HIV infection alone. Vascular malperfusion is suggestive of a hypoxic insult arising from a compensatory response to meet the fetal oxygen and nutrient demands of an AAP. Placentae from HIV infected women on antiretroviral treatment were characterised by vascular malperfusion.

The Use of Contrast-Enhanced Multidetector Computed Tomography Imaging in Advanced Abdominal Pregnancy.

An advanced abdominal pregnancy is defined as an extrauterine pregnancy over twenty weeks gestation with a fetus living, or showing evidence of having once lived, in the mother's abdominopelvic cavity. Our case is a 35-year-old patient with a 23-week extrauterine pregnancy, with a congenital head defect (scaphocephaly and hydrocephalus), located in the left side of the maternal abdomen with a period of gestation of 23 weeks, who underwent preoperative imaging with contrast-enhanced multidetector computed tomography (CE-MDCT). CT imaging provided significant information on the placenta and its arterial supply/venous drainage and confirmed the presence of an arteriovenous malformation of the right uterine artery. CT imaging also allowed planning of preoperative uterine artery coil embolization.

Hemoperitoneum during removal of the placenta in advanced abdominal pregnancy with live fetus delivered at 37 weeks of gestation. A case report in a low-resource setting and literature review.

INTRODUCTION AND IMPORTANCE: Advanced abdominal pregnancy (> 20 weeks gestation) is a rare condition life-threatening for mother and fetus. CASE PRESENTATION: A 31-years-old African woman presented from a rural district to Mutoyi Hospital for first gynecological evaluation after 37 weeks of amenorrhea, abdominal pain and vaginal bleeding. An ultrasound revealed an extra-uterine fetus. Laparotomy was done and a live fetus weighing 1980 g was delivered. Removal of the placenta, triggered massive bleeding (5000 mL) with shock. After re-laparotomy for post-operative ileus and hemoperitoneum, the mother and infant were discharged in good health. CLINICAL DISCUSSION: Viable fetus can be delivered after an advanced abdominal pregnancy. Removal of the placenta is controversial. We review currently medical literature on advanced abdominal pregnancy and propose a management of the placenta in these patients. CONCLUSION: We recommended to leave the placenta in situ, to avoid intraoperative bleeding. Placenta involution during follow-up can be revealed by ultrasound, colordoppler and ß-hCG serum level decrease.

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.

Advanced abdominal pregnancy: a search for consensus. Review of literature along with case report.

BACKGROUND: Advanced abdominal pregnancy is a highly morbid form of extrauterine gestation that demands skilled management. Despite advancement in antenatal care and imaging modalities, undiagnosed cases of advanced abdominal pregnancies are still reported. We report a case of asymptomatic abdominal pregnancy with healthy fetus advanced till 40 + 4 weeks period of gestation. Her diagnosis was not established even after obstetrical evaluation and cesarean section at primary care hospital. To the best of our knowledge, less than 10 postdated cases of abdominal pregnancy have been reported so far in the literature. This case emphasizes the need to re-awaken awareness and high index of suspicion to diagnose such cases. Details of all the cases pertaining to advanced abdominal pregnancies reported after 2013 were reviewed and summarized. METHODOLOGY: We searched electronic medical database in English using keywords related to abdominal pregnancy. Bibliographies of the relevant articles of advanced abdominal pregnancy published from 2013 onwards were reviewed and then cross searched to identify further relevant studies. RESULTS: A total of 26 cases of advanced abdominal pregnancy including index one were reviewed. All preoperatively diagnosed cases of abdominal pregnancy at earlier gestation were given conservative management and resulted in live births. The incidence of malformations in live births was 24%. CONCLUSION: We are of considered opinion that conservative strategy is a feasible option in selected cases of advanced abdominal pregnancy yet there is a need of standardization of treatment principles for such cases to optimize fetomaternal outcome.

Diagnosis of abdominal pregnancy still a challenge in low resource settings: a case report on advanced abdominal pregnancy at a tertiary facility in Western Kenya.

Abdominal pregnancy is a rare form of ectopic pregnancy, occurring in 1: 10,000 to 1: 30,000 pregnancies and accounting for up to 1.4% of all ectopic pregnancies. It is classified as primary or secondary depending on the site of fertilization. However, when it does happen, it may remain unnoticed until term because the pregnancy can appear normal during clinical examination. Advanced abdominal pregnancy is associated with high mortality rate for both the mother and the baby at 1-20% and 40-95% respectively. We report a case of a 30-year-old female para 2+0, gravida 3 at 35+1 who presented at a Tertiary facility in Eldoret Kenya with one-day history of per vaginal bleeding and 2 weeks' history of no fetal movements. The importance of this case report is to highlight the challenges associated with diagnosis of advanced abdominal pregnancy in low resource settings. Ultrasound alone cannot be relied on to make the diagnosis. Whenever an induction is not working, abdominal pregnancy should be considered.

Advanced abdominal pregnancy, with live fetus and severe preeclampsia, case report.

BACKGROUND: Abdominal pregnancy may account for up to 1.4% of all ectopic pregnancies. The incidence of abdominal pregnancy differs in various literatures and ranges between 1:10,000 pregnancies to 1:30, 000 pregnancies. The clinical symptoms of an uncomplicated abdominal pregnancy are unspecific. There are reports of maternal and fetal survival from advanced abdominal pregnancies. CASE PRESENTATION: Our case was a 26 years old gravida 4, para 3 (2 alive, one early neonatal death) woman. She presented to Felegehiwot Referal Hospital with a principal complaint of vomiting, epigastric pain, headache, and blurring of vision. Emergency cesarean delivery was decided with the impression of bicornuate uterus with intrauterine pregnancy, intrauterine growth restriction and sever preeclampsia.it was found to be advanced abdominal pregnancy. Placenta was removed and pack was used to control bleeding. Both the mother and neonate were discharged in a good condition. CONCLUSION: Abdominal pregnancy with live fetus is an extremely rare condition and requires a high index of suspicion. Endometrial cavity may not be required for development of severe preeclampsia and packing is effective in controlling bleeding in selected cases.

Conservative Management and Planned Surgery for Periviable Advanced Extrauterine Abdominal Pregnancy with Favorable Outcome: Report of Two Cases.

Advanced abdominal pregnancy is an extremely rare condition that poses diagnostic and management challenges. A high index of suspicion and careful assessment of the patient's symptoms, supplemented with obstetric ultrasound, and magnetic resonance imaging, are crucial for timely diagnosis and management to prevent life-threatening complications. The presence of periviable fetuses in advanced abdominal pregnancies increases the challenge to achieve a balance between maternal and fetal benefits and risks. Early diagnosis and management decisions via a multidisciplinary approach and planned delivery are of paramount importance to minimize complications and achieve favorable maternal and fetal outcomes. Even in the setting of oligohydramnios and suspected preterm premature rupture of membranes, in-patient conservative management and an individualized planned surgical approach that includes removing or leaving the placenta in place are appropriate for managing the periviable abdominal pregnancy.

Advanced abdominal ectopic pregnancy: lessons from three cases from Zimbabwe and a literature appraisal of diagnostic and management challenges.

We report three cases illustrating difficulties in diagnosis and challenges with management of the placenta in a low-resource country where ultrasound scanning, methotrexate, interventional radiology or blood products are often not accessible for the majority of patients. Even in situations where an ultrasound scan is available prenatally as in our three cases, the diagnosis is often missed. All the cases presented with vague abdominal symptoms, which are common in pregnancy anyway. Only one case was correctly diagnosed before surgery by ultrasound scan. For the two cases in the second trimester as expected the fetuses did not survive. The one advanced pregnancy had a good perinatal outcome. Maternal morbidity and mortality usually results from perioperative hemorrhage from the placental attachment site. The most important aspect of management is the management of the placenta. In the two cases with second trimester pregnancies, it was possible to remove the placentas, even though blood loss was significant, hemostasis was achieved at surgery. All three mothers recovered well and survived.

Advanced abdominal pregnancy: an increasingly challenging clinical concern for obstetricians.

Advanced abdominal pregnancy is rare. The low incidence, high misdiagnosis rate, and lack of specific clinical signs and symptoms explain the fact that there are no standard diagnostic and treatment options available for advanced abdominal pregnancy. We managed a case of abdominal pregnancy in a woman who was pregnant for the first time. This case was further complicated by a concurrent singleton intrauterine pregnancy; the twin pregnancy was not detected until 20 weeks of pregnancy. The case was confirmed at 26 weeks gestational age using MRI to be an abdominal combined with intrauterine pregnancy. The pregnancy was terminated by cesarean section at 33 + 5 weeks gestation. We collected the relevant data of the case while reviewing the advanced abdominal pregnancy-related English literature in the Pubmed, Proquest, and OVID databases. We compared and analyzed the pregnancy history, gestational age when the diagnosis was confirmed, the placental colonization position, the course of treatment and surgical processes, related concurrency rate, post-operative drug treatment programs, and follow-up results with the expectation to provide guidance for other physicians who might encounter similar cases.

Conservative management of an advanced abdominal pregnancy at 22 weeks.

Objective We report an uneventful conservative approach of an advanced abdominal pregnancy discovered at 22 weeks of gestation. Study Design This study is a case report. Results Attempting to extend gestation of an advanced abdominal pregnancy is not a common strategy and is widely questioned. According to the couple's request, the management consisted in continuous hospitalization, regular ultrasound scan, and antenatal corticosteroids. While the woman remained asymptomatic, surgery was planned at 32 weeks, leading to the birth of a preterm child without any long-term complications. Placenta was left in situ with a prophylactic embolization, and its resorption was monitored. Conclusion Depending on multidisciplinary cares and agreement of the parents, when late discovered, prolonging advanced abdominal pregnancy appears to be a reasonable option.

A multicentre study of advanced abdominal pregnancy: a review of six cases in low resource settings.

Abdominal pregnancy has remained a big challenge worldwide especially in developing countries where there are limitations in diagnostic resources. The most important approach is to be vigilant for the unexpected as most patients present with no specific symptoms or clinical signs. It also poses great challenges in diagnosis and management, and is associated with a lot of morbidity and mortality. This series of six cases, each presenting in a peculiar way, typically illustrates these issues. The cases were managed in three different hospitals in the last 15 years. These series is aimed at highlighting the atypical presenting features of advanced abdominal pregnancy and the need for vigilance when there is suspicion of a case. It is also aimed at showing the difficulty of diagnosis and management of advanced abdominal pregnancy in low resource environment.

Advanced abdominal pregnancy: a case report of good maternal and perinatal outcome / Embarazo abdominal avanzado: reporte de un caso con un buen resultado materno y perinatal

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.