Ectopic Pregnancy: Abdominal
Name: Mrs M.Devi
Age/Sex: 18/F
Address: Rautahat.
Chief Complaints: Per Vaginal bleeding for 8-9 days
Abdominal Pain with increase in severity for 8-9 days
History of Present illness: Patient was well 10 days back,
then he developed bleeding per vaginal and lower abdominal pain.
Bleeding was fresh blood and 5-10ml in amount 3-4 times a day.
Abdominal pain was continuous mild pain, with no radiation. There is
no history of fever, nausea or vomiting. Bowel and bladder habit
normal.
Past History: No h/o Hypertension, Tuberculosis, Diabetes
Mellitus, asthma, blood transfusion and surgery.
Personal history: No history of alcohol, smoking,
contraceptives or any kinds of drugs history.
Family History: No h/o Hypertension, Tuberculosis, Diabetes
Mellitus, asthma, abortion, twins pregnancy, genetic diseases or
cancer in the family.
Menstrual and Obstetrics History: 14,4-6/30 . married for
2.5 yrs. LMP: 2064-11-02, history of one spontaneous abortion of
about 2 months. She is of 30+ wks of gestation.
Clinical Examination:
General Examination:
General characteristics: fair, conscious and cooperative
No pallor, icterus, oedema or dehydration
Vitals: Pulse: 80/min, Temp: Afebrile, Blood Pressure: 120/80
mmHg.
Abdominal Palpation: soft, mild tender in lower abdomen,
uterus felt of 18 wks size.
Per Vaginal Examination: Os closed, Gloves stained with
blood.
Respiratory: Bilateral vesicular breath sound, no added
sound.
Cardiovascular: normal 1st and 2nd heart
sound with no murmur.
Provisional Diagnosis: Ectopic Pregnancy
Differential Diagnosis: Fibroid, tubo ovarian mass,
endometriosis, Acute PID
USG Report: ? Abdominal Pregnancy ??Ruptured Ectopic Pregnancy
Patient was transferred to OT for Laparotomy. Post Operative findings are:
Uterus bulky, soft. Macerated Fetus of about18 wks size, 10cm in length with few lanugo hairs and nails developed. Eyelids transparent & closed, lying in abdominal cavity, adherent and entangled with lesser omentum. Placenta and Left tube attached with intestine. Umbilical cord attached with fetus.
Rt tube and ovary normal. Fimbrial cyst present
in right side.
Hemoperitonium of about 100ml.
Total Blood Loss: 250+100=350ml
Post Operative Procedure: Laparotomy with Left Salphingectomy.
Post Operative Diagnosis: Rupture of Old Tubal Pregnancy with
secondary Abdominal Pregnancy
Similar another case :
Abdominal pregnancy is a rare, life-threatening condition. Case:
A 30-year-old pregnant, gravida 3, para 1, was presented to hospital
at 38 weeks gestation. She suffered from abdominal pain at 16 weeks
gestation. At admission, obstetrical examination and transabdominal
ultrasonography revealed that it was uterine pregnancy with a single
living fetus and oligohydramnios. The diagnosis of abdominal
pregnancy was made till intrasurgical operation. An amniotomy was
performed and a normal neonatal female was extracted as breech. A
subtotal abdominal hysterectomy was conducted. No postoperative
complications were observed. Conclusion: We present this case
to call attention to the clinicians and ultrasonographers that it is
always important to bear in mind the possibility of abdominal
pregnancies especially in the condition of fetal malpresentation,
history of abdominal pain, malformations or oligohydramnion.
Author
Fen Li
Department of Maternal and Child Health Care
First Hospital of Xi'an Jiaotong University, Xi'an
-
Introduction: Abdominal Pregnancy
An ectopic pregnancy occasionally aborts backwards down a tube,
or bursts out of it without killing the patient, and embeds itself
elsewhere in her abdominal cavity. Sometimes, an ovum is fertilized
outside a tube on the surface of an ovary, and then implants itself
in the abdominal cavity. Such an ectopic may die at any stage, or
proceed to term. An abdominal pregnancy is thus a rare complication
of an ordinary ectopic pregnancy, so that in areas where ectopic
pregnancies are common, the incidence of abdominal pregnancies is
increased also. An abdominal pregnancy causes comparatively few
symptoms. None of them are individually diagnostic, so the diagnosis
depends on the sum of many clues, none of which is enough by itself.
A patient with an abdominal pregnancy may present with: (1)
Persistent abdominal pain from about 26 to 28 weeks onwards of
variable severity, which is not well localized. (2) Her ''uterus'
(in reality the gestational sac) is ill-defined, and feels ''odd',
when you palpate it. The fetal parts may be abnormally easy or
abnormally difficult to feel. The lie of the baby is often abnormal,
and may be persistently transverse or oblique. (3) The features of
(1 and 2) accompanied by the failure of her ''uterus' to enlarge,
typically at 32 weeks, and a dead baby. (4) The features of (1 and
2) combined with a ''uterus' that distends more than it should, so
that you suspect polyhydramnios. (5) Postmaturity ([mt]40 weeks).
(6) A dead baby which she does not expel, either spontaneously or
with oxytocin.
Read more similar cases at
juxtrasoundmed.org
britannica
Baby saved of Abdominal Pregnancy
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