Anesthetic management of an undiagnosed advanced extrauterine pregnancy under combined spinal-epidural anesthesia

Abstract

Advanced extrauterine (abdominal) pregnancy is extremely rare. Management of such a pregnancy invariably involves a laparotomy under general anesthesia and has never been reported to have been performed in its entirety under neuraxial anesthesia. We report a case of a 26-year-old multigravida who presented with severe abdominal pain at 32 weeks and 1 day gestational age and on laparotomy was found to have an undiagnosed extrauterine pregnancy. We believe this is the very first reported case of advanced extrauterine pregnancy, diagnosed at laparotomy, performed under combined spinal-epidural anesthesia and successfully managed in its entirety, without conversion to general anesthesia. The postoperative period was uneventful, with both mother and neonate being discharged 3 days after surgery. Through this case we discuss the management and outcome of this rare presentation performed successfully under neuraxial anesthesia.