Abdominal pregnancy is a rare variant of ectopic pregnancy which occurs when the gestational sac is implanted outside the uterus, ovaries and fallopian tubes. It constitutes approximately 1% of ectopic pregnancies, 1 and has a reported incidence of one in 2200 to one in 10,200 of all pregnancies, and one in 6000 births. 2 While abdominal pregnancies may reach term the fetal mortality rate varies from 30% to 95% 3,4 and the maternal mortality rate can be as high as 20%. 2 The fetal abnormality rates range from 30% to 100%, most of which are secondary to oligohydramnios and a constricted extrauterine environment, such as lung hypoplasia and pressure related deformities. 2 Hence, with the high risk to the mother and the improbability of a normal, viable fetus, immediate termination and removal of the pregnancy is advisable. Although successful non-surgical management of abdominal pregnancy has been reported, 5 surgical management is usually required. While this is traditionally done via a laparotomy, there have been five cases of laparoscopic management of abdominal pregnancy reported in the English literature.We report the identification and laparoscopic management of an early primary abdominal pregnancy. To the best of our knowledge, this is the first report in Australia of an abdominal pregnancy managed laparoscopically.
Doubt about pre-operative carbohydrate supplementationWe commend Fawcett and Thomas for their review of pre-operative fasting recommendations [1] and applaud their candid acknowledgement of the mounting evidence of lack of clinical benefit for oral pre-operative carbohydrate loading (preCHO), considered an essential element of the enhanced recovery after surgery (ERAS)We wish to mount further direct challenges to the concept of preCHO, on several grounds. The subjective benefits of preCHO, namely the reduction in anxiety, distress, thirst and hunger [1][2][3], are relative to the dietary habit of the subject during the preceding weeks, as much as they are to the immediate duration of restriction of food and water. A predominantly carbohydrate-based 'standard' diet (such as has been advised by national advisory bodies for several decades) accentuates these symptoms, whereas the widespread adoption of reduced fasting times for both food and water (6 h and 2 h, respectively), reduces the impact of this acute deprivation. Indeed, preCHO has been shown to be of benefit only when compared with fasting without water, but negligible when compared with water[1]. The analogy drawn between surgical stress and exercise, with respect to lactate production and carbohydrate loading, is both false and out-dated. In the context of exercise, lactic acid is produced when
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