Hemoperitoneum during removal of the placenta in advanced abdominal pregnancy with live fetus delivered at 37 weeks of gestation. A case report in a low-resource setting and literature review

Muroni, Mirko; Butoyi, Jean Marie Vianney; Shimirimana, Mwajuma; Mulemangabo, Mimico; Nkurunziza, Joel; Caravaggi, Paola

doi:10.1016/j.ijscr.2021.105694

Cited by 5 publications

(10 citation statements)

References 29 publications

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“…Extra-uterine pregnancies are surprisingly easy to miss [3, 5], both clinically and with ultrasound [1]. This is tragic, as women with extra-uterine pregnancies cannot labor.…”

Section: Introductionmentioning

confidence: 99%

“…A previous case report [1] and review [2] published in Gynecologic and Obstetric Investigation highlight the importance of advanced extra-uterine pregnancy. The condition is rare, but occurs more commonly in lower middle- than high-income countries [3]. Reasons include high rates of pelvic infection and less access to clinical surveillance: women with ectopic pregnancy are less likely to have the diagnosis made, and occasionally undiagnosed ectopic/abdominal pregnancies persist till late pregnancy [3, 4].…”

Section: Introductionmentioning

confidence: 99%

“…The condition is rare, but occurs more commonly in lower middle- than high-income countries [3]. Reasons include high rates of pelvic infection and less access to clinical surveillance: women with ectopic pregnancy are less likely to have the diagnosis made, and occasionally undiagnosed ectopic/abdominal pregnancies persist till late pregnancy [3, 4]. The placenta behaves as a parasite and invades any available adjacent blood vessels, such as those supplying the broad ligament, uterus, adnexa, omentum, bowel, and pelvis.…”

Section: Introductionmentioning

confidence: 99%

“…The placenta behaves as a parasite and invades any available adjacent blood vessels, such as those supplying the broad ligament, uterus, adnexa, omentum, bowel, and pelvis. The maternal mortality may be as high as 18% [3] to 27% [2].…”

Section: Introductionmentioning

confidence: 99%

“…The surgical removal of advanced extra-uterine pregnancies may prove to be anything from remarkably simple to catastrophic [3]. It is prudent to assemble an experienced team of surgeons and anesthetists [4], and have adequate blood available to replace surgical loss.…”

Section: Introductionmentioning

confidence: 99%

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Foley Catheter Tourniquet for Uncontrollable Extra-Uterine Placental Hemorrhage: Description of a Novel Surgical Technique

Hofmeyr

Majeke

Nassali

2021

Gynecol Obstet Invest

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Introduction Hemorrhage from a partially or fully detached placenta with an advanced abdominal pregnancy can be profuse and catastrophic. The general approach to placenta management is removal of “all or nothing’’. In the event of acute hemorrhage, every attempt to achieve hemostasis quickly is critical. The Foley catheter has shown utility when used to control placental hemorrhage or as a temporary tourniquet applied around structures surrounding the implantation site to aid placental removal with minimal hemorrhage. We report use of the technique on four occasions with good surgical outcomes. Case Presentation We report a case of a 33 year-old primigravida admitted at term with an ultrasound diagnosis of breech presentation and placenta previa grade four. Her pre-operative clinical assessment however, raised suspicion of an abdominal pregnancy. At laparotomy, a live female infant was delivered from the extra-uterine gestation sac, weighing 3640g and with an Apgar score of 7 and 6 at one and 5 minutes respectively. Following delivery, there was profuse bleeding from the partially detached distal portion of the placenta that derived rich blood supply from the poorly accessible posterior pelvic wall. We applied a novel, simple and effective surgical technique for minimizing blood loss from the partially detached placenta using a Foley’s catheter tourniquet that was applied between the detached and still attached parts of the placenta. The tourniquet was left in situ and removed at laparotomy 4 days later. The placenta was not removed. The mother and baby did well postoperatively and were discharged after 10 and 21 days respectively in good condition. The surgical technique was similarly used in 3 additional cases with good clinical outcomes. Discussion Use of a Foley catheter as an intraoperative tourniquet has become accepted as a useful technique in obstetric and gynecological surgery. We describe a simple life saving technique of applying a Foley tourniquet across a partially detached placenta following an advanced extra-uterine pregnancy to control acute hemorrhage. Conclusion We recommend that surgeons keep in mind the option of intraoperative tourniquets when faced with uncontrollable bleeding as a short-term or medium-term temporizing measure.

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“…Extra-uterine pregnancies are surprisingly easy to miss [3, 5], both clinically and with ultrasound [1]. This is tragic, as women with extra-uterine pregnancies cannot labor.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Foley Catheter Tourniquet for Uncontrollable Extra-Uterine Placental Hemorrhage: Description of a Novel Surgical Technique

Hofmeyr

Majeke

Nassali

2021

Gynecol Obstet Invest

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Early abdominal pregnancy in a spontaneous heterotopic pregnancy: Case report

Khouloud,

Maroua,

Montacer

et al. 2024

International Journal of Surgery Case Reports

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Unknown advanced abdominal pregnancy in low resource setting: A case report

Farsi,

Mercanzin,

Tiru

et al. 2024

Int. J. Clin. Obstet. Gynaecol.

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Background: Abdominal pregnancy is a rare, life-threatening condition. Case: A 39-year-old pregnant, gravida 2, para 1 (spontaneous vaginal delivery), was presented to hospital at 36+6 weeks gestation on account of abdominal pain. She underwent an emergency caesarean section due to foetal distress. The diagnosis of abdominal pregnancy was not made until intrasurgical operation was carried out and a live baby of 2.8 kg was delivered via laparotomy with an intact uterus. However, to avoid major bleeding the placenta was left in situ along with gauze packs to achieve hemostasis. A second laparotomy was eventually carried out to remove the gauzes after one week, but the placenta, since being firmly attached to the postero-lateral pelvic wall, was not removed. Conclusions: The present case recalls the attention to the possible misdiagnosed abdominal pregnancy in low resource settings where ultrasound scan is often not available and to the management of placenta after delivering the foetus.

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Hemoperitoneum during removal of the placenta in advanced abdominal pregnancy with live fetus delivered at 37 weeks of gestation. A case report in a low-resource setting and literature review

Cited by 5 publications

References 29 publications

Foley Catheter Tourniquet for Uncontrollable Extra-Uterine Placental Hemorrhage: Description of a Novel Surgical Technique

Foley Catheter Tourniquet for Uncontrollable Extra-Uterine Placental Hemorrhage: Description of a Novel Surgical Technique

Early abdominal pregnancy in a spontaneous heterotopic pregnancy: Case report

Unknown advanced abdominal pregnancy in low resource setting: A case report

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