Successful operative management of an intact second trimester abdominal pregnancy with additional preoperative selective catheter embolization and postoperative methotrexate therapy

Abstract

SummaryBackgroundAbdominal pregnancy is a rare condition that may lead to severe complications.Case ReportThe authors report the case of a 17-week intact abdominal pregnancy diagnosed in the course of an investigation of lower abdominal pain. Ultrasonography and MR examination revealed an intact abdominal pregnancy. Subsequent angiography was performed to occlude the supportive artery of the pregnancy by selective embolization. The pregnancy was terminated safely by laparotomy a day later. The placenta was left in the abdominal cavity because of the high risk of massive and often uncontrollable bleeding, and treatment with methotrexate was applied postoperatively.ConclusionsPreoperative embolization and the postoperative methotrexate therapy facilitate the safe surgical treatment of abdominal pregnancy.

P16.03: Disseminated trophoblastic peritoneal implants at uterine muscle, ovary, and peritoneal wall after dilatation and curettage

“…Ultrasound is considered to be the gold standard for obtaining exact information about the location of the pregnancy and its relation to the surrounding organs. In cases where ultrasonography is equivocal, MRI may be informative 1 . Management options of abdominal ectopic pregnancies vary greatly mainly due to the rarity of cases.…”

P16.02: Placenta localisation in first trimester pregnancies of women undergoing in vitro fertilization treatment

“…Baumgarten 1,2 , L.T. Polanski 1,2 , B. Campbell 2 , N.J. Raine-Fenning 1,2 Objectives: Late placentation may be associated with adverse pregnancy outcomes such as miscarriage, pre-eclampsia and growth restriction. Increasing numbers of studies are looking into the assessment of the early placenta.…”

“…Ultrasound is considered to be the gold standard for obtaining exact information about the location of the pregnancy and its relation to the surrounding organs. In cases where ultrasonography is equivocal, MRI may be informative 1 .…”

Management of an unusual major obstetric haemorrhage in a resource-poor setting

“…5 Ramphal et al considered that conservative management of the placenta is safe, ''as long as [the patient is] hospitalized in a centre with immediate recourse to emergency interventions''. 6 Other management options such as embolisation techniques 7 and postoperative methotrexate 8 are not currently feasible in Malawi.…”