Abdominal pregnancy is not encountered commonly, and management of the placenta is controversial.
A 33-year-old woman presented with an abdominal pregnancy at 33 weeks' gestation with fetal death. The placental vasculature was embolized preoperatively. Following operative delivery. of the fetus, the placenta was left in situ in efforts to preserve fertility given its implantation on the reproductive organs. The patient suffered prolonged postoperative ileus but otherwise did well. Placental function ceased after two months.
Placental vasculature embolization is a management option for a retained placenta associated with abdominal pregnancy.
"To our knowledge, preoperative embolization of dead or unviable fetuses and postoperative emergency hemostatic procedures have only been reported to date.10 11
12 Oneko et al identified nine advanced abdominal pregnancies between 20 and 42 weeks of gestation in a low-resource center between 1999 and 2007. "
[Show abstract][Hide abstract] ABSTRACT: Objective We report an uneventful conservative approach of an advanced abdominal pregnancy discovered at 22 weeks of gestation.
Study Design This study is a case report.
Results Attempting to extend gestation of an advanced abdominal pregnancy is not a common strategy and is widely questioned. According to the couple's request, the management consisted in continuous hospitalization, regular ultrasound scan, and antenatal corticosteroids. While the woman remained asymptomatic, surgery was planned at 32 weeks, leading to the birth of a preterm child without any long-term complications. Placenta was left in situ with a prophylactic embolization, and its resorption was monitored.
Conclusion Depending on multidisciplinary cares and agreement of the parents, when late discovered, prolonging advanced abdominal pregnancy appears to be a reasonable option.
[Show abstract][Hide abstract] ABSTRACT: Transcatheter arterial embolization has become a major treatment modality in a variety of clinical applications, including management of bleeding related to a broad spectrum of obstetric and gynecologic disorders. Embolotherapy has a well-documented role in the management of pelvic and genital tract hemorrhage in the postpartum and postoperative/postcesarean setting. It is also an integral part in the treatment armamentarium of abdominal and cervical ectopic pregnancy, arteriovenous malformation, and gynecologic neoplasms, including more recently, uterine leiomyomata. Based on experiences accumulated over the past decades, embolotherapy has been proven to be highly effective with success rate in the 90 to 100% range in the appropriate clinical settings. It provides visualization of the bleeding site and enables targeted, minimally invasive therapy to achieve hemostasis, which allows preservation of the uterus and hence fertility. In hospitals where experienced personnel and technology is available, transcatheter arterial embolization should be considered in the emergent management of obstetric and gynecologic hemorrhage, particularly when local and conservative measures fail to attain hemostasis.
Seminars in Interventional Radiology 09/2006; 23(3):240-8. DOI:10.1055/s-2006-948761
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