Angiographic arterial embolization and computed tomography-directed drainage for the management of hemorrhage and infection with abdominal pregnancy.

Hemorrhage during or after surgery, pelvic abscess, bowel obstruction, and prolonged febrile morbidity can complicate the puerperal course of the gravida after removal of an extrauterine fetus with nondisturbance of the extrauterine placenta. In this report we describe the successful angiographic arterial gelfoam embolization of the placental vascular bed to control heavy postoperative hemorrhage in a mother suffering adult respiratory distress syndrome after removal of the fetal portion of her abdominal pregnancy. Six weeks later, computed tomography (CT)-directed drainage by catheter of a placental abscess was performed. Selective angiographic transcatheter embolization with gelfoam is a useful tool for the control of hemorrhage in the gravida who is an unfavorable operative candidate or who may present technical hemostasis problems peculiar to the placenta with abdominal pregnancy. Later use of CT-directed catheter drainage of the infected residual placental mass provided a nonoperative means of treatment.

Abdominal pregnancy: current concepts of management.

Nine cases of early and six cases of advanced abdominal pregnancy managed at the University of Mississippi Medical Center over a 20-year period are reviewed. An incidence of one abdominal pregnancy in 4857 deliveries occurred in this series. A perinatal mortality rate of 83% and no maternal mortality were noted, in contrast to published rates of 40-95% and 0.5-18%, respectively. Important current concepts of management include difficulty in diagnosis, predisposing risk factors, suggestive signs and symptoms, the diagnostic role of ultrasound, and the appropriate surgical management of parturients with this ominous pregnancy complication.