Article

[Post-term pregnancy in the broad ligament.]

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Abstract

Post-term pregnancy in the broad ligament is rarely described in the literature. A 33-year-old woman, grava 2 para 1, not followed-up during gestation was admitted at 44 weeks of gestation. The fetus was dead and in transversal position, as shown by ultrasound. A cesarean section was performed and the fetus was extracted from the right broad ligament. The placenta was inserted on the surface of the posterior wall of the uterus. Blood loss was estimated at 1200mL and the patient received isogroup total blood. There was no major complication.

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... The patient was not followed up during gestation and presented to the hospital at the 44th week. The fetus was dead in transversal position and was extracted from the right broad ligament by laparotomy [41]. This case showed that a broad ligament pregnancy can reach term without any serious symptoms. ...
... Laparotomies have been reported in order to treat a wide spectrum of broad ligament pregnancies, starting with 5 weeks of amenorrhea [60], till broad ligament pregnancies at term [15,36] which were admitted for an emergency cesarian section. Finally a case of a post-term broad ligament pregnancy has been reported [41]. ...
... The treatment of retroperitoneal pregnancy also represents a great challenge for clinicians. The most of retroperitoneal pregnancies are diagnosed and removed during the early stages of gravidity, but there are reports on broad ligament pregnancies with viable term fetuses 19,20,30,[36][37][38][39][40][41] , even post term 42 . ...
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Introduction. Retroperitoneal ectopic pregnancy is extremely rare, but potentially fatal condition due to possible massive hemorrhage, representing a great challenge to clinicians. Case report. We presented early retroperitoneal pregnancy in a patient with previous caesarean section, diagnosed at the sixth gestational week, located in the left broad ligament, primary treated by laparoscopy, which had to be converted to laparotomy due to massive intraoperative bleeding from the implantation site. Conclusion. High index of suspicion, combined with carefully interpreted clinical and ultrasound findings are crucial for the timely diagnosis of retroperitoneal pregnancy, before the occurrence of severe bleeding. The rising, even plateau of serum β-human chorionic gonadotropin (β-HCG) levels without identification of uterine or ectopic (tubal) pregnancy should cause suspicion on ectopic pregnancy in unusual location.
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Mrs S, 30 years old, G4 P3+0 at 38 weeks of gestation, was admitted to the emergency ward on September 16, 2007, with complaints of mild pain in the abdomen off and on for the past 3 days. She had no other complaints. She was totally unsupervised with a grossly uneventful antenatal period except that she had a significant history of undergoing bilateral tubal lapro-ligation in the periovulatory phase in a lapro-ligation Camp. On clinical examination, her vitals were stable and the fundal height was corresponding to “32 weeks of gestation” baby was in transverse lie and there was oligohydramios. FHS was 136 beats/min regular. She was not in labour. Non-stress test was reactive. Ultrasonography revealed a single live pregnancy corresponding to 36 weeks of gestation, Type-III placenta previa with grade-3 maturity, and AFI was 8 cms with no obvious congenital anomalies. Her Hb % was 8 g% and other biochemical parameters were within the normal range. She was taken up for elective cesarean section on September 18, 2007, with one unit of blood. On opening the abdomen, the uterus was of 10 weeks’ size separate from the pregnancy and had deviated to the extreme left. However, round ligaments could not be seen at that moment. An incision was made in the relatively avascular area and a female baby was extracted with the APGAR of 6, 7, 8, and a birth weight of 2,800 g. The abdominal cavity was reexamined; it was found that the placenta was attached to the outer right lateral wall of the uterus. The conceptus was well encased between the two leaves of the right broad ligament, and the tube and round ligament were stretched over this pseudogestational sac containing the fetus and placenta. There were absolutely no adhesions anywhere in the abdominal cavity. Total abdominal hysterectomy with right salpingectomy was done and the specimen sent for histopathologic examination (Fig. 1). Her post-operative period was grossly uneventful. She received one unit of blood transfusion post-operatively. The baby was placed at her bedside and breast fed since the delivery. Both the mother and baby were discharged on the eighth post-operative day in good general condition. She came for a follow-up at 6 weeks post-partum. She was well and healthy along with her baby. Fig. 1 Specimen showing abdominal hysterectomy with right salpingectomy
Article
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Introduction Advanced abdominal (extrauterine) pregnancy is a rare condition with high maternal and fetal morbidity and mortality. Because the placentation in advanced abdominal pregnancy is presumed to be inadequate, advanced abdominal pregnancy can be complicated by pre-eclampsia, which is another condition with high maternal and perinatal morbidity and mortality. Diagnosis and management of advanced abdominal pregnancy is difficult. Case presentation We present the case of a 33-year-old African woman in her first pregnancy who had a full-term advanced abdominal pregnancy and developed gross ascites post-operatively. The patient was successfully managed; both the patient and her baby are apparently doing well. Conclusion Because most diagnoses of advanced abdominal pregnancy are missed pre-operatively, even with the use of sonography, the cornerstones of successful management seem to be quick intra-operative recognition, surgical skill, ready access to blood products, meticulous post-operative care and thorough assessment of the newborn.
Article
A broad ligament pregnancy is an extremely rare condition. The eventuality of such pregnancies reaching full term is even rarer. A full-term broad ligament pregnancy occurring through a rent in a previous lower segment caesarean scar has only been mentioned in literature but not reported. Our patient is an unbooked case, reported to us at 39 weeks of pregnancy. On clinical examination, an ultrasound and an MRI, a diagnosis of abdominal pregnancy was made. Ultimately the final diagnosis was made only on laparotomy. A broad ligament pregnancy was found with a rent in the previous caesarean scar communicating the fetal sac.
Article
Abdominal pregnancy is a rare localization of ectopic pregnancy, more frequently observed in underdeveloped countries. We report a case of abdominal pregnancy carried to full term delivery, discovered at a time of a cesarean for low site of placenta attachment. Discovery of an abdominal pregnancy at the time of C-section seems exceptional with clinical and ulrasonographic surveillance of pregnancy. The objective of our article is to emphasize the importance of localizing the appendix at the first quarter echography and the utility of the endovaginal ulrasound.
Abdominal pregnancy (AP) is defined as the implantation and development of the fertilised egg in the cavity of peritoneum. It causes severe perinatal morbity and mortality. Underline the epidemiologic, diagnostic, therapeutic and prognostic aspects of the AP. Retrospective study conducted at Maternité Joséphine Bongo (maternity hospital) and at the Centre Hospitalier de Libreville (hospital centre) from January 1999 to December 2009 on 19 cases of abdominal pregnancies. The frequency of AP in Libreville is one per 4447 deliveries (0.2 ‰) and one per 141 tubal ectopic pregnancies (0.7%). The mean age was 30.5 ± 7.2 years old and the mean parity 2.7 ± 1.7. The mean term of occurrence was 24.3 weeks of amenorrhoea (WA) with extremes at 14 and 39 WA. The diagnosis was made in the face of abdominal and pelvic pains in all the patients and an amenorrhoea in 11 cases (57%). It was confirmed by ultrasound scan in 14 cases (73.7%) and further to a laparotomy in five (26.3%) patients. We had two live births at 39 and 38 WA with respective birth weights of 2,380 and 2,550 g. Expulsion of the placenta was complete in seven (36.8%) cases. Five (26.3%) patients experienced hemorrhagic complications. AP is a rare pathology. Its diagnosis beyond of the second quarter is difficult with an often-pejorative foetal forecast.
Abdominal pregnancy is a rare localization of ectopic pregnancy, more frequently observed in underdeveloped countries. We report a case of abdominal pregnancy carried to full term delivery, discovered at a time of a cesarean for low site of placenta attachment. Discovery of an abdominal pregnancy at the time of C-section seems exceptional with clinical and ulrasonographic surveillance of pregnancy. The objective of our article is to emphasize the importance of localizing the appendix at the first quarter echography and the utility of the endovaginal ulrasound.
Article
We report a case of primary abdominal pregnancy observed at the maternity clinic in Befelatanana, Madagascar. A 36-year-old woman, gravida 2, para 2, with no medical history presented at 40 weeks and 2 days of amenorrhea for sudden disappearance of fetal movements. Prenatal visits had been performed on an irregular basis by a private-practice midwife. Fetal death was confirmed by ultrasonographic examination and subsequent plain abdominal radiographic imaging suggested abdominal pregnancy. Laparotomy confirmed diagnosis of primitive abdominal pregnancy. Postoperative recovery was uneventful. Based on this rare case, the literature is reviewed and the importance of clinical follow-up and ultrasonography in detection and management is stressed.
La grossesse abdominale : à propos d'un cas observé à Madagascar
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