Abdominal pregnancy is a unique type of ectopic pregnancy that can be easily missed in routine obstetric practice. Current studies estimate an incidence of 1.3% (1-4). This type of pregnancy can be classified as primary or secondary, based on whether fertilization occurs in the peritoneal cavity followed by peritoneal implantation or whether normal fertilization is followed by rupture of the uterine or tube wall, leading to secondary implantation in the peritoneal cavity (5-7). The affected woman may not have any major complaints other than some discomfort. The abdomen enlarges, just as in normal pregnancy. To an unsuspecting radiologist doing a routine ultrasonography, the growing intra-abdominal fetus may appear quite healthy and have normal systemic development. We present the case of a 24-yearold patient who presented with loss of fetal movement at 26 weeks and subsequently was diagnosed with abdominal pregnancy by magnetic resonance imaging (MRI). We emphasize the importance of MRI in suspected abdominal pregnancies. In our case, the MRI both provided a definitive diagnosis and revealed the significant anatomical relationships of the intra-abdominal organs, thus aiding in the surgical management. Case reportA 24-year-old female (gravida 2, para 1, living 1) presented with a sixmonth history of amenorrhea, vague abdominal pain, and loss of fetal movements for 10 days. She had no history of vaginal bleeding or passage of clear fluid. She had undergone a caesarean section for her first child one year previously. There was no history of contraceptive use. The patient consulted a local hospital after she noticed reduced fetal movement, and an intra-uterine fetal demise was diagnosed following an ultrasound scan. Medical induction for delivery of the non-viable fetus was attempted, but despite adequate doses of an inducing agent, there were no signs of progress into labor. There was history of some form of attempted instrumentation. Following the unsuccessful induction, the patient was referred to our institute.On examination, the patient was pale with a heart rate of 90/min and blood pressure of 110/68 mmHg. An obstetric examination revealed a fundal height corresponding to 28 weeks, with a transverse lie and easily palpable fetal parts. The fetal heart could not be auscultated. The external os was closed on vaginal and speculum examination, and minimal bleeding was noted. Apart from mild anemia (hemoglobin, 11 g/dL), the laboratory results were within normal limits.A preliminary ultrasound scan with a 3-5 MHz curvilinear probe (Siemens Sonoline G50, Siemens Medical Solutions, Issaquah, Washington, USA) at our institute revealed a non-viable fetus with a transverse lie (Fig. 1). A normally echogenic uterine wall was not noted, which raised the suspicion of an abdominal pregnancy. The placental ABSTRACT Secondary abdominal pregnancy is a rare type of ectopic pregnancy. Following fertilization, the blastocyst escapes from the uterine cavity and implants in the peritoneal cavity. The early antenatal diagnosis and i...
Accessory parotid glands are a common clinical occurrence and usually drain into the main Stenson's duct by small ductules and thereby, into the buccal cavity. Presence of an accessory parotid gland with an ectopic fistulous duct is a rare occurrence. We present the imaging findings in a case of right accessory parotid gland with ectopic fistulous duct associated with bilateral pre-aural appendages. Diagnostic workup was done by ultrasonography, sono-fistulography, contrast digital fistulography, contrast digital sialography and computed tomography fistulography. Imaging showed a right accessory parotid gland lying anterior to and separate from the main parotid gland draining via an ectopic fistulous duct opening over the right cheek. The child was managed surgically by internalisation of the duct to open into the buccal mucosa and excision of pre-aural appendages.
Isomerism or Heterotaxy syndromes are rare multifaceted congenital anomalies with multi-system involvement. Grouped under the broad category of Situs Ambiguous defects, these often pose diagnostic difficulties due to their varied and confusing anatomy. Since patients rarely survive into adulthood due to cardiovascular complications, the etiology and natural history of such conditions are not fully understood. Imaging provides the most accurate non invasive method for diagnosis and thereby, prognosis in such cases. We present a case of right sided Isomerism with complex cardiac anomalies in a 17 year old adolescent, who presented with dysphagia as one of the main complaints. Multi modality imaging demonstrated the intricate abnormalities in vital systems.
Introduction Neonatal resuscitation guidelines routinely recommend delayed cord clamping. 1 This recommendation is applicable to preterm neonates, provided they are born vigorous and crying. It is associated with increased haemoglobin, preventing neonatal anaemia. 2 Failure to delay cord clamping may necessitate recurrent neonatal blood transfusions. 3 Delayed cord clamping reduces the risk of parenteral nutrition associated liver disease, necrotising enterocolitis, and intra-ventricular haemmorhage. 4 Case Series Two extremely premature neonates were born by spontaneous vaginal delivery, at 23+4 and 26 weeks respectively. Prior to delivery, the neonatal team requested delayed cord clamping. Both infants cried spontaneously and were vigorous at birth. At 1 minute, APGAR scores were 6 and 8 respectively. However both umbilical cords were immediately clamped. The first infant required five red cell transfusions during his neonatal admission. He developed necrotizing enterocolitis, managed medically. He had two episodes of suspected late-onset sepsis. Cranial ultrasound revealed a left-sided Grade 3 intraventricular haemorrhage. The second neonate required three red cell transfusions during her NICU admission. She developed parenteral nutrition associated liver disease. This was characterized by an elevated direct bilirubin. She also developed Klebsiella pneumonia. Discussion Non-adherence to delayed cord clamping may cause chronic anaemia in preterm neonates. Multiple transfusions compound the risk of acute transfusion-related reactions. These include fever, haemolysis and anaphylaxis. Transfusions are an independent risk factor for parenteral nutrition associated liver disease. Transfusions also have an immunosuppressive effect, increasing the risk of pneumonia and late onset neonatal sepsis. Transfusion-related alloantibodies increase the lifelong risk of organ transplant rejection. Delayed cord clamping is associated with a decreased risk of intraventricular haemorrhage. Among four-year-old children, it is correlated with improved fine motor and social development. Conclusion Blood transfusions in preterm neonates should be avoided where possible.Delayed cord clamping provides a practical, non-invasive method to prevent neonatal anaemia and transfusions. Clinical knowledge and communication between neonatal and obstetric teams is fundamental to optimising patient care.
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