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AJP Rep 2016; 06(03): e301-e308
DOI: 10.1055/s-0036-1588003
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Hassan M. Harirah
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
,
J. Michael Smith
2   The University of Texas Medical Branch at Galveston, Galveston, Texas
,
C. Luke Dixon
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
,
Gary D. V. Hankins
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
› Author Affiliations
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Publication History

20 June 2016

14 July 2016

Publication Date:
01 September 2016 (online)

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Abstract

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.

Keywords

advanced abdominal pregnancy - extrauterine - periviable - obstetric ultrasound - oligohydramnios - MRI - placenta - conservative management
 

  • References

  • 1 Farquhar CM. Ectopic pregnancy. Lancet 2005; 366 (9485) 583-591
    CrossrefPubMedGoogle Scholar
  • 2 Karaer O, Ilkgül O, Oruç S. Primary omental pregnancy on the gastrocolic ligament. South Med J 2007; 100 (4) 403-404
    CrossrefPubMedGoogle Scholar
  • 3 Atrash HK, Friede A, Hogue CJ. Abdominal pregnancy in the United States: frequency and maternal mortality. Obstet Gynecol 1987; 69 (3 Pt 1): 333-337
    PubMedGoogle Scholar
  • 4 Ekele BA, Ahmed Y, Nnadi D, Ishaku K. Abdominal pregnancy: ultrasound diagnosis aided by the balloon of a Foley catheter. Acta Obstet Gynecol Scand 2005; 84 (7) 701-702
    CrossrefPubMedGoogle Scholar
  • 5 Ramphal S, Moodley J. Advanced extrauterine pregnancy. Curr Obstet Gynaecol 1998; 8 (2) 90-95
    CrossrefPubMedGoogle Scholar
  • 6 De Muelenaere HM. Advanced abdominal pregnancy and preeclampsia: A case report and literature review. Obstetrics and Gynaecology Forum 2003; 13 (3) 22-26
    PubMedGoogle Scholar
  • 7 Dahab AA, Aburass R, Shawkat W, Babgi R, Essa O, Mujallid RH. Full-term extrauterine abdominal pregnancy: a case report. J Med Case Reports 2011; 5: 531
    CrossrefPubMedGoogle Scholar
  • 8 Opare-Addo HS, Deganus S. Advanced abdominal pregnancy: a study of 13 consecutive cases seen in 1993 and 1994 at Komfo Anokye Teaching Hospital, Kumasi, Ghana. Afr J Reprod Health 2000; 4 (1) 28-39
    CrossrefPubMedGoogle Scholar
  • 9 Worley KC, Hnat MD, Cunningham FG. Advanced extrauterine pregnancy: diagnostic and therapeutic challenges. Am J Obstet Gynecol 2008; 198 (3) 297.e1-297.e7
    CrossrefPubMedGoogle Scholar
  • 10 Huang K, Song L, Wang L, Gao Z, Meng Y, Lu Y. Advanced abdominal pregnancy: an increasingly challenging clinical concern for obstetricians. Int J Clin Exp Pathol 2014; 7 (9) 5461-5472
    PubMedGoogle Scholar
  • 11 Mpogoro F, Gumodoka B, Kihunrwa A, Massinde A. Managing a live advanced abdominal twin pregnancy. Ann Med Health Sci Res 2013; 3 (1) 113-115
    CrossrefPubMedGoogle Scholar
  • 12 Ludwig M, Kaisi M, Bauer O, Diedrich K. The forgotten child—a case of heterotopic, intra-abdominal and intrauterine pregnancy carried to term. Hum Reprod 1999; 14 (5) 1372-1374
    CrossrefPubMedGoogle Scholar
  • 13 Roberts RV, Dickinson JE, Leung Y, Charles AK. Advanced abdominal pregnancy: still an occurrence in modern medicine. Aust N Z J Obstet Gynaecol 2005; 45 (6) 518-521
    CrossrefPubMedGoogle Scholar
  • 14 Cotter A, Izquierdo L, Heredia F. Abdominal pregnancy. Available at: https://www.sonoworld.com/fetus/page.aspx?id=1032 . Accessed April 15, 2016
    PubMedGoogle Scholar
  • 15 Stanley JH, Horger III EO, Fagan CJ, Andriole JG, Fleischer AC. Sonographic findings in abdominal pregnancy. AJR Am J Roentgenol 1986; 147 (5) 1043-1046
    CrossrefPubMedGoogle Scholar
  • 16 Bertrand G, Le Ray C, Simard-Emond L, Dubois J, Leduc L. Imaging in the management of abdominal pregnancy: a case report and review of the literature. J Obstet Gynaecol Can 2009; 31 (1) 57-62
    PubMedGoogle Scholar
  • 17 Varma R, Mascarenhas L, James D. Successful outcome of advanced abdominal pregnancy with exclusive omental insertion. Ultrasound Obstet Gynecol 2003; 21 (2) 192-194
    CrossrefPubMedGoogle Scholar
  • 18 Brouard KJ, Howard BR, Dyer RA. Hepatic Pregnancy Suspected at Term and Successful Delivery of a Live Neonate With Placental Attachment to the Right Lobe of the Liver. Obstet Gynecol 2015; 126 (1) 207-210
    CrossrefPubMedGoogle Scholar
  • 19 Patel C, Feldman J, Ogedegbe C. Complicated abdominal pregnancy with placenta feeding off sacral plexus and subsequent multiple ectopic pregnancies during a 4-year follow-up: a case report. J Med Case Reports 2016; 10: 37
    CrossrefPubMedGoogle Scholar
  • 20 Cotter AM, Jacques EG, Izquierdo LA. Extended field of view sonography: a useful tool in the diagnosis and management of abdominal pregnancy. J Clin Ultrasound 2004; 32 (4) 207-210
    CrossrefPubMedGoogle Scholar
  • 21 Tasnim N, Mahmud G. Advanced abdominal pregnancy—a diagnostic and management dilemma. J Coll Physicians Surg Pak 2005; 15 (8) 493-495
    PubMedGoogle Scholar
  • 22 Sentilhes L, Ambroselli C, Kayem G , et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol 2010; 115 (3) 526-534
    CrossrefPubMedGoogle Scholar
  • 23 Marcellin L, Ménard S, Lamau MC , et al. Conservative management of an advanced abdominal pregnancy at 22 weeks. AJP Rep 2014; 4 (1) 55-60
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Fouelifack FY, Fouogue JT, Fouedjio JH, Sando Z. Viable abdominal pregnancy: a case report in Yaoundé (Cameroon). Pan Afr Med J 2014; 18: 181
    PubMedGoogle Scholar
  • 25 Smrtka MP, Gunatilake R, Miller MJ, Heine RP, Brown HL. Improving the management of an advanced extrauterine pregnancy using pelvic arteriography in a hybrid operating suite. AJP Rep 2012; 2 (1) 63-66
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Practice bulletins No. 139: premature rupture of membranes. Obstet Gynecol 2013; 122 (4) 918-930
    CrossrefPubMedGoogle Scholar
  • 27 Kohl T, Geipel A, Tchatcheva K , et al. Life-saving effects of fetal tracheal occlusion on pulmonary hypoplasia from preterm premature rupture of membranes. Obstet Gynecol 2009; 113 (2 Pt 2): 480-483
    CrossrefPubMedGoogle Scholar
  • 28 Rahman MS, Al-Suleiman SA, Rahman J, Al-Sibai MH. Advanced abdominal pregnancy—observations in 10 cases. Obstet Gynecol 1982; 59 (3) 366-372
    PubMedGoogle Scholar