Embolization for advanced abdominal pregnancy with a retained placenta: A case report
Divisions of Gynecologic Oncology and Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of South Florida, Tampa, USA. The Journal of reproductive medicine
(Impact Factor: 0.7).
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.
Available from: Alexandre Mignon
- "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. "
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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.
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ABSTRACT: Cervical or abdominal pregnancies are rare forms of ectopic pregnancy and their management differs for different authors. Besides, the literature is mainly made of case-reports. The aim is to propose one or more management possibilities, keeping in mind that the level of proof obtained from the references used is insufficient to be affirmative. For cervical pregnancy, although hysterectomy is the reference treatment (especially in advanced pregnancy or hemorrhagic life-threatening forms), technical improvements in ultrasonography make feasible the diagnosis of non or weakly symptomatic forms, which could be treated conservatively in order to preserve fertility of these women. In this diagnostic situation the present treatment standard is methotrexate combined with intra-amniotic feticide in case of viable cervical pregnancy. Diagnosis of abdominal pregnancy is often made late. Treatment consists in laparotomy which enables better vascular control. Placental ablation remains as often as not dangerous and in most cases, it is better to abandon the attempt.
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