Full Term Extrauterine Abdominal Pregnancy

Abstract

Extrauterine abdominal pregnancy is extremely rare and is frequently missed during antenatal care, despite the routine use of obstetrics ultrasound. A 23 year old primigravida at 39 weeks of gestation was admitted to the department on December 2, 2012, in routine hour with transverse lie with oligohydramnios. On examination her vitals and laboratory investigation were within normal limits. One of the ultrasonographic scanning done by radiologist at 35 wk. 3 days gestation demonstrated a single live intrauterine fetus of CGA 33 wk. 1 day with transverse lie, fundal gr II placenta and AFI-10 cm. Ultrasonography done at the department on the day of admission demonstrated single live intrauterine fetus with transverse lie and AFI-3.8 cm and EFW 2.4 Kg and placenta was right anterior.. She was planned for elective caesarean section on account of transverse lie and oligohydramnios at term. At laparotomy the following findings were made: Secondary abdominal pregnancy arising from right tubal ectopic rupture and making pseudogestational sac with meconium stained liquor. Omentum, right tube and ovary were adhered to sac. The uterus and left tube and ovary were healthy and normal. Other abdominal organs were normal. A 1.5 Kg live male baby with good Apgar score and incompletely formed mandible extracted from pseudogestational sac. There was significant bleeding from pseudogestational sac and patient went in shock during intraoperative period. One unit whole blood transfused during intraoperative period. Placenta was adherent to the pseudogestational sac so Psudogestational sac was removed with placenta in situ and right sided salpingo-oophrectomy was also done due to their adherence. Hemostasis was secured. The patient and baby progressed well and were discharged on the seventh postoperative day.

Endometrial Factor in Unexplained Infertility and Recurrent Implantation Failure

“…20 It has been extensively reported that blastocysts can implant in the uterus as well as in a wide variety of ectopic sites such as the broad ligament, omentum, and bowel, with reported successful term pregnancies in humans. [21][22][23] However, in contrast to the uterus, implantation occurs in ectopic sites regardless of hormonal conditioning, 20 highlighting that the uterus is the major controlling partner in the implantation process through the window of implantation (WOI) which corresponds to the critical window in the menstrual cycle that determines whether implantation can occur or not (►Fig. 1B).…”