Prenatal Diagnosis and Management of Advanced Abdominal Pregnancy in Dr. Moewardi Hospital Surakarta: A Case Series
DOI:
https://doi.org/10.26911/thejmch.2021.06.05.01Abstract
Background: The abdominal pregnancy is a pregnancy anywhere in the abdominal cavity other than the tube, ovary, and broad ligament. Abdominal pregnancy has 7.7 times greater risk than tubal pregnancy and 90 times greater than intrauterine pregnancy. This study aims to reveal the diagnosis and treatment of abdominal pregnancy in Dr. Moewardi Hospital Surakarta.
Subjects and Method: This was a case series study conducted at Dr. Moewardi Hospital Surakarta. This study report three cases of advanced abdominal pregnancy at Dr Moewardi Hospital (2019 – 2020), that consisted of two cases of advanced abdominal pregnancy to term, and one advanced abdominal pregnancy with acute abdomen.
Case presentation: Case 1 (it was found abdominal pregnancy at 30 weeks), the condition of the mother and the fetus was good, the pregnancy was continued until the gestational age was term. The patient was given corticosteroids for lung maturation and magnesium sulfate for neuroprotection. Case 2 (an abdominal pregnancy was found at term), it was decided to immediately terminate it with good preoperative preparation. Both patients in case 1 and case 2 had good result in both the mother and the fetus. The placenta was left in situ in both cases to prevent massive bleeding and injury to the gastrointestinal organs. Case 3 (advanced abdominal pregnancy with acute abdominal symptoms) decided to undergo an emergency laparotomy and removal of the placenta.
Conclusion: Abdominal pregnancy must be diagnosed and managed properly to reduce maternal mortality and morbidity. In advanced abdominal pregnancy, it could be considered to continue the pregnancy until the term. The placenta management of in situ without methotrexate might be considered in cases of abdominal pregnancy.
Keywords:
abdominal pregnancy, prenatal diagnosis, treatmentReferences
Agarwal N, Odejinmi F (2014). Early abdominal ectopic pregnancy: challenges, update and review of current management. Obstet Gynaecol. 16(3): 193-198. doi: 10.1111/tog.12109
Bertrand G, Le RC, Simard-Émond L, Dubois J, Leduc L (2009). Imaging in the management of abdominal pregnancy: a case report and review of the literature. J Obstet Gynecol Can. 31 (1): 57-62. doi: 10.1016/s17012163(16)340555
Gilani S, Syed M, (2019). A case of advanced abdominal pregnancy with viable fetus at term. J Med Sci. 27(2): 147-149.
Hailu FG, Yihunie GT, Essa AA, Tsega KW (2017). Advanced abdominal pregnancy, with live fetus and severe pre-eclampsia, case report. BMC Preg-nancy Childbirth 17(1): 1-4. doi: 10.1186/s128840171437
Jabbar NAA, Saquib S, Mohammed Talha, WE (2018). Successful Management of Abdominal Pregnancy: Two Case Reports. Oman Med J. 33(2): 171–175. doi: 10.5001/omj.2018.32
Marcellin L, Ménard S, Lamau MC, Mignon A, Aubelle M, Grangé G, Goffinet F (2014). Conservative Management of an Advanced Abdominal Pregnancy at 22 Weeks. Am J Perinatol Rep 4(01): 055–060. doi: 10.1055/s00341371749.
Nassali MN, Benti TM, Bandani-Ntsabele, M, Musinguzi E (2016). A case report of an asymptomatic late term abdominal pregnancy with a live birth at 41 weeks of gestation. BMC Res Notes. 9(1). doi:10.1186/s1310401618446
Tolefac PN, Abanda MH, Minkande JZ, Priso EB (2017). The challenge in the diagnosis and management of an advanced abdominal pregnancy in a resource-low setting: a case report. J Med Case Rep. 11(1):199. doi: 10.1186/s1325601713691.
Worley KC, Hnat MD, Cunningham FG (2008). Advanced extrauterine pregnancy: diagnostic and therapeutic challenges. Am J Obstet Gynecol. 198(3): 297.e1–297.e7. doi: 10.1016/j.ajog.2007.09.044.
Xu L, Xiang Z, Wu T, Feng S (2019). Advanced Abdominal Pregnancy with Retained Placenta and Methotrexate-Induced Severe Bone Marrow Suppression: A Case Report. Biomed J Sci Technol Res. 19: 14487-14488. doi: 10.26717/BJSTR.2019.19.003341
