Advanced ectopic abdominal pregnancy: Case report and review of the literature

Authors

  • María Fernanda Escobar-Vidarte
  • Gabriela Caicedo-Herrera
  • Juan David Solarte-Erazo
  • Laura Sofía Thomas-Pérez
  • Diana María Dávalos-Pérez
  • Jaime López-Tenorio
  • Angélica María Forero-Ladino

DOI:

https://doi.org/10.18597/rcog.2983

Keywords:

Abdominal pregnancy, ectopic pregnancy, bleeding, pregnancy outcome

Abstract

Objective: The aim of this study is to report two  cases of advanced ectopic abdominal pregnancy with good maternal/perinatal outcomes, and to review the literature available regarding the management of the placenta and the prognosis for this condition. 

Materials and methods: Description of two cases of advanced ectopic abdominal pregnancies with viable fetuses and favourable perinatal outcomes, in which the placenta was removed. The cases were seen at a Level IV institution in the city of Cali, Colombia. Review of the literature registered in the Medline data base via Pubmed using the search terms “abdominal pregnancy”, “splenic pregnancy”, “hepatic pregnancy”, “omental pregnancy” and “peritoneal pregnancy”. The search was limited to articles published in English and Spanish during the past 12 years.

Results: Overall, 228 references were retrieved, of which 42 articles reporting on a total of 74 patients with ectopic abdominal pregnancy met the inclusion criteria. Regarding the management of the placenta, it was removed in 42 cases (58%). There were 4 cases of maternal mortality (4,1%) all of them due to postpartum bleeding. Complications occurred in 60 patients (81%), bleeding being the most frequent in 38 of them (51%). As for perinatal outcome, perinatal mortality was 43.8%.

Conclusion: Placental management is the the key determinant factor of the frequency of maternal complications. Prospective studies to assess the safest and most effective management of this condition are required.

Author Biographies

María Fernanda Escobar-Vidarte

Ginecoobstetra, Universidad del Valle; maestría en Epidemiologia Clínica; Universidad de la Frontera, Chile; especialista en Cuidado Intensivo, Universidad del Valle, University of Pittsburgh. Jefe de la Unidad de Alta Complejidad Obstétrica, Fundación Clínica Valle del Lili; coordinadora de la Sección de Cuidado Crítico Obstétrico, Asociación Colombiana de Medicina Crítica y Cuidado Intensivo, Cali (Colombia).mayaev@hotmail.com

Gabriela Caicedo-Herrera

Médicos Generales, Universidad Icesi, en periodo de servicio social obligatorio. Cali (Colombia).

Laura Sofía Thomas-Pérez

Médicos Generales, Universidad Icesi, en periodo de servicio social obligatorio. Cali (Colombia).

Diana María Dávalos-Pérez

Médico especialista en epidemiologia y salud pública. Jefe del Departamento de Salud Pública, Universidad Icesi, Fundación Valle del Lili, Cali (Colombia).

Jaime López-Tenorio

Ginecoobstetra; especialista en Perinatología, Fundación Valle del Lili, Cali (Colombia).

Angélica María Forero-Ladino

Médico rural de investigaciones clínicas, Servicio de Ginecología y Obstetricia, Grupo de Investigación en Unidad de Alta Complejidad Obstétrica, Fundación Valle del Lili, Cali (Colombia).

References

The American College of Obstetrics and Gynecologist. Ectopic pregnancy. 2011 [visitado 2017 Feb 15]. Disponible en: https://www.acog.org/-/media/For-Patients/faq155.pdf?dmc=1&ts=20170125T1456405281.

Nkusu Nunyalulendho D, Einterz EM. Advanced abdominal pregnancy: Case report and review of 163 cases reported since 1946. Rural Remote Health. 2008;8:1087.

Atrash HK, Friede A, Hogue CJ. Abdominal pregnancy in the United States: Frequency and maternal mortality. Obstet Gynecol. 1987;69:333-7.

Costa SD, Presley J, Bastert G. Advanced abdominal pregnancy. Obstet Gynecol Surv. 1991;46:515-25.

Okafor I, Ude A, Aderibigbe ASO, Amu O, Udeh P, Obianyo N, et al. Abdominal pregnancy-a case report. J West Afr Coll Surg. 2011;1:121-30.

Martin JN Jr, Sessums JK, Martin RW, Pryor JA, Morrison JC. Abdominal pregnancy: Current concepts of management. Obstet Gynecol. 1988; 71:549-57.

Naim NM, Ahmad S, Siraj HH, Ng P, Mahdy ZA, Razi ZR. Advanced abdominal pregnancy resulting from late uterine rupture. Obstet Gynecol. 2008;111(2 Pt 2):502-4.

Bayless RB. Nontubal ectopic pregnancy. Clin Obstet Gynecol. 1987; 30:191-9.

Little KJ, Green MM. Abdominal gestation. J Emerg Med. 1995;13:195-8.

Ali V, Saldana LR, BaIat IY, Katragadda R. Pitfalls in sonographic diagnosis of abdominal pregnancy. South Med J.1981;74:477-9.

Audifred JR, Herrera A, Gonzalez MG, Estrada SF. Embarazo ectópico intraligamentario. Ginecol Obstet Mex. 2013;81:211-4.

Mahi M, Boumdin H, Chaouir S, Salaheddine T, Attioui D, Amil T, et al. A new case of abdominal pregnancy. J Radiol. 2002;83:989-92.

Oneko O, Petru E, Masenga G, Ulrich D, Obure J, Zeck W. Management of the placenta in advanced abdominal pregnancies at an East african tertiary referral center. J Womens Health (Larchmt).2010;19:1369-75.

Harirah HM, Smith JM, Dixon CL, Hankins GD. Conservative management and planned surgery for periviable advanced extrauterine abdominal pregnancy with favorable outcome: Report of two cases. AJP Rep. 2016;6:e301-8.

Udigwe GO, Eleje GU, Ihekwoaba EC, Udegbunam OI, Egeonu RO, Okwuosa AO. Acute intestinal obstruction complicating abdominal pregnancy: Conservative management and successful outcome. Case Rep Obstet Gynecol. 2016;2016:2576280.

Nassali MN, Benti TM, Bandani-Ntsabele M, Musinguzi E. A case report of an asymptomatic late term abdominal pregnancy with a live birth at 41 weeks of gestation. BMC Res Notes. 2016;9:31.

El-Agwany AS, El-Badawy El-S, El-Habashy A, El-Gammal H, Abdelnaby M. Secondary advanced abdominal pregnancy after suspected ruptured cornual pregnancy with good maternal outcome: A case with unusual gangrenous fetal toes and ultrasound diagnoses managed by hysterectomy. Clin Med Insights Womens Health. 2016;9:1-5.

Bhoil R, Aggarwal N, Jhobta A, Sharma S. Advanced abdominal pregnancy with successful outcome. Intern Emerg Med. 2016;11:877-8.

Brouard KJ, Howard BR, Dyer RA. Hepatic Pregnancy Suspected at Term and Successful Delivery of a Live Neonate With Placental Attachment to the Right Lobe of the Liver. Obstet Gynecol. 2015;126:207-10.

Mengistu Z, Getachew A, Adefris M. Term abdominal pregnancy: A case report. J Med Case Rep. 2015;9:168.

Kim MC, Manyanga H, Lwakatare F. Secondary abdominal pregnancy in human immunodeficiency virus-positive woman. Obstet Gynecol Sci. 2016;59:535-8.

Gidiri MF, Kanyenze M. Advanced abdominal ectopic pregnancy: Lessons from three cases from Zimbabwe and a literature appraisal of diagnostic and management challenges. Womens Health. 2015;11:275-9.

Lee C. Abdominal pregnancy in a low-resource setting. Obstet Gynecol. 2015;125:1039-41.

Bohiltea R, Radoi V, Tufan C, Horhoianu IA, Bohiltea C. Abdominal pregnancy - Case presentation. J Med Life. 2015;8:49-54.

Dabiri T, Marroquin GA, Bendek B, Agamasu E, Mikhail M. Advanced extrauterine pregnancy at 33 weeks with a healthy newborn. Biomed Res Int. 2014;2014:102479. doi: 10.1155/2014/102479.

Fouelifack FY, Fouogue JT, Fouedjio JH, Sando Z. Viable abdominal pregnancy: A case report in Yaoundé (Cameroon). Pan Afr Med J. 2014;18:181.

Huang K, Song L, Wang L, Gao Z, Meng Y, Lu Y. Advanced abdominal pregnancy: An increasingly challenging clinical concern for obstetricians. Int J Clin Exp Pathol. 2014;7:5461-72.

Marcellin L, Ménard S, Lamau MC, Mignon A, Aubelle MS, Grangé G, et al. Conservative management of an advanced abdominal pregnancy at 22 weeks. AJP Rep. 2014;4:55-60.

Joshi B, Aggarwal N, Singh A. Obstetrical catastrophe averted: Successful outcome of an abdominal pregnancy. Am J Emerg Med. 2014;32:1299.

Matovelo D, Ng’walida N. Hemoperitoneum in advanced abdominal pregnancy with a live baby: A case report. BMC Res Notes. 2014;7:106.

Renfroe S, Dajani NK, Pandey T, Magann EF. Role of serial MRI assessment in the management of an abdominal pregnancy. BMJ Case Rep. 2013;2013: bcr2013200495.

Smrtka MP, Gunatilake R, Miller MJ, Heine RP, Brown HL. Improving the management of an advanced extrauterine pregnancy using pelvic arteriography in a hybrid operating suite. AJP Rep. 2012;2:63-6.

Aliyu LD, Ashimi AO. A multicentre study of advanced abdominal pregnancy: A review of six cases in low resource settings. Eur J Obstet Gynecol Reprod Biol. 2013;170:33-8.

Mpogoro F, Gumodoka B, Kihunrwa A, Massinde A. Managing a live advanced abdominal twin pregnancy. Ann Med Health Sci Res. 2013;3:113-5.

Pradhan M, Sreenivas M, Singh B, Behera C, Dikshit PC. Sudden death in advanced abdominal pregnancy: A case report and discussion of the related medicolegal issues. Med Sci Law. 2013;53:90-2.

Masukume G, Sengurayi E, Muchara A, Mucheni E, Ndebele W, Ngwenya S. Full-term abdominal extrauterine pregnancy complicated by post-operative ascites with successful outcome: A case report. J Med Case Rep. 2013;7:10.

Kim MJ, Bae JY, Seong WJ, Lee YS. Sonographic diagnosis of a viable abdominal pregnancy with planned delivery after fetal lung maturation. J Clin Ultrasound. 2013;41:563-5.

Mittal SK, Singh N, Verman AK, Agarwal H, Kulkarni CD, Kanaujia R. Fetal MRI in the pre-operative diagnosis and assessment of secondary abdominal pregnancy: A rare sequela of a previous caesarean section. Diagn Interv Radiol. 2012;18:496-502.

Collins SL, Grant D, Black RS, Vellayan M, Impey L. Abdominal pregnancy: A perfusion confusion? Placenta. 2011;32:793-5.

Dahab AA, Aburass R, Shakkat W, Babgi R, Essa O, Mujallid RH. Full term extrauterine abdominal pregnancy: A case report. J Med Case Rep. 2011;5:531.

Baffoe P, Fofie C, Gandau BN. Term abdominal pregnancy with healthy newborn: A case report. Ghana Med J. 2011;45:81-3.

Brewster EM Sr, Braithwaite EA, Brewster EM Jr. Advanced abdominal pregnancy: A case report of good maternal and perinatal outcome. West Indian Med J. 2011;60:587-9.

Ramphal SR, Moodley J, Rajaruthnam D. Hepatic pregnancy managed conservatively. Trop Doct. 2010; 40:121-2.

Gupta P, Sehgal A, Huria A, Mehra R. Secondary abdominal pregnancy and ir associated diagnostic and operative dilemma: Three case reports. J Med Case Rep. 2009;3:7382.

Sunday-adeoye I, Twomey D, Egwuatu EV, Okonta PI. A 30 year review of advanced abdominal pregnancy at the mater misericordiae hospital, a fikpo, southeastern Nigeria (1976-2006). Arch Gynecol Obstet. 2011;283:19-24.

Worley KC, Hnat MD, Cunningham FG. Advanced extrauterine pregnancy: Diagnostic and therapeutic challenges. Am J Obstet Gynecol. 2008;198:297.e1-7.

Isah AY, Ahmed Y, Nwobodo EI, Ekele BA. Abdominal pregnancy with a full term live fetus: Case report. Ann Afr Med. 2008;7:198-9.

Promsonthi P, Herabutya Y. Uterocutaneous fistula in term abdominal pregnancy. Eur J Obstet Gynecol Reprod Biol. 2007;132:239-41.

Lockhat F, Corr P, Ramphal S, Moodley J. The value of magnetic resonance imaging in the diagnosis and management of extra-uterine abdominal pregnancy. Clin Radiol. 2006;61:264-9.

Roberts RV, DickinsonI JE, Leung Y, Charles AK. Advanced abdominal pregnancy: Still an occurrence in modern medicine. Aust N Z J Obstet Gynaecol. 2005;45:518-21.

Tshivhula F, Hall DR. Expectant management of an advanced abdominal pregnancy. J Obstet Gynaecol. 2005;25:298.

Godyn JJ, Hazra A, Gulli VM. Subperitoneal placenta accreta succenturiate in the case of a successful nearterm extrauterine abdominal pregnancy. Hum Pathol. 2005:36:922-6.

Cetinkaya MB, Kokcu A, Alper T. Follow up of the regression of the placenta left in situ in an advanced abdominal pregnancy using the Cavalieri method. J Obstet Gynaecol Res. 2005;31:22-6.

Xiao GH, Chen DJ, Sun XF, She RQ, Mai YM. Abdominal pregnancy: Full-term viable baby. Eur J Obstet Gynecol Reprod Biol. 2005;118:117-8.

How to Cite

1.
Escobar-Vidarte MF, Caicedo-Herrera G, Solarte-Erazo JD, Thomas-Pérez LS, Dávalos-Pérez DM, López-Tenorio J, et al. Advanced ectopic abdominal pregnancy: Case report and review of the literature. Rev. colomb. obstet. ginecol. [Internet]. 2017 Mar. 31 [cited 2024 May 18];68(1):71-82. Available from: https://revista.fecolsog.org/index.php/rcog/article/view/2983

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2017-03-31
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