A unique case of coexisting intrauterine and abdominal pregnancy which progress to term with a positive birth outcome.
Abdominal pregnancy
Ectopic pregnancy
Heterotopic pregnancy
Spontaneous heterotopic pregnancy
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
24 Mar 2022
24 Mar 2022
Historique:
received:
31
05
2021
accepted:
09
03
2022
entrez:
25
3
2022
pubmed:
26
3
2022
medline:
5
4
2022
Statut:
epublish
Résumé
The term heterotopic pregnancy is defined as a uterine pregnancy coexisting with a second pregnancy in an extrauterine location. Spontaneous, full-term heterotopic pregnancy with alive birth is very rare. The diagnosis and management of such exceptionally unique case is difficult. When the patient presented with an advanced labor with no antenatal care follow up and with no risk factors is even more challenging for poorly equipped facilities like ours. A 25 years old gravida 3, para 2 (both are alive) mother presented to the labor and delivery ward of Bele Primary Hospital, Southern Ethiopia with the complaint of pushing down pain of 18 h duration. Immediately after arrival, she gave birth to a 3300gm female neonate spontaneously. After delivery, an abdominal mass was recognized and manual exploration of the uterus was done to look for the presence of after coming second twin but the uterus was empty. On ultrasound examination, there was an alive fetus in transverse lie outside the uterus. With the impression of 2nd twin in a separate horn of bicornuate uterus and to rule out abdominal pregnancy, laparotomy was done. On laparotomy, there was abdominal pregnancy in the Pouch of Douglas with an intact amniotic sac. The sac was attached with the left broad ligament, left ovary, small bowel mesentery, and posterior wall of the uterus. The sac opened, a 1600gm alive female neonate with features of fetal growth restriction and left club foot was delivered. The placenta was detached spontaneously and removed without any complication. The coexistence of spontaneous full-term intrauterine with advanced abdominal ectopic pregnancy is one of the rarest forms of heterotopic pregnancy. Every health professional should bear in mind that intrauterine and extrauterine pregnancy may happen simultaneously and it can progress to term without any symptoms. Ultrasound is the diagnostic method of choice but the existence of an intra-uterine pregnancy cannot rule out ectopic pregnancy. The life-threatening complication of abdominal ectopic pregnancy is bleeding from the detached placental site. Therefore, the decision to remove the placenta should be individualized.
Sections du résumé
BACKGROUND
BACKGROUND
The term heterotopic pregnancy is defined as a uterine pregnancy coexisting with a second pregnancy in an extrauterine location. Spontaneous, full-term heterotopic pregnancy with alive birth is very rare. The diagnosis and management of such exceptionally unique case is difficult. When the patient presented with an advanced labor with no antenatal care follow up and with no risk factors is even more challenging for poorly equipped facilities like ours.
CASE PRESENTATION
METHODS
A 25 years old gravida 3, para 2 (both are alive) mother presented to the labor and delivery ward of Bele Primary Hospital, Southern Ethiopia with the complaint of pushing down pain of 18 h duration. Immediately after arrival, she gave birth to a 3300gm female neonate spontaneously. After delivery, an abdominal mass was recognized and manual exploration of the uterus was done to look for the presence of after coming second twin but the uterus was empty. On ultrasound examination, there was an alive fetus in transverse lie outside the uterus. With the impression of 2nd twin in a separate horn of bicornuate uterus and to rule out abdominal pregnancy, laparotomy was done. On laparotomy, there was abdominal pregnancy in the Pouch of Douglas with an intact amniotic sac. The sac was attached with the left broad ligament, left ovary, small bowel mesentery, and posterior wall of the uterus. The sac opened, a 1600gm alive female neonate with features of fetal growth restriction and left club foot was delivered. The placenta was detached spontaneously and removed without any complication.
CONCLUSIONS
CONCLUSIONS
The coexistence of spontaneous full-term intrauterine with advanced abdominal ectopic pregnancy is one of the rarest forms of heterotopic pregnancy. Every health professional should bear in mind that intrauterine and extrauterine pregnancy may happen simultaneously and it can progress to term without any symptoms. Ultrasound is the diagnostic method of choice but the existence of an intra-uterine pregnancy cannot rule out ectopic pregnancy. The life-threatening complication of abdominal ectopic pregnancy is bleeding from the detached placental site. Therefore, the decision to remove the placenta should be individualized.
Identifiants
pubmed: 35331173
doi: 10.1186/s12884-022-04561-x
pii: 10.1186/s12884-022-04561-x
pmc: PMC8944064
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
243Informations de copyright
© 2022. The Author(s).
Références
BMJ Case Rep. 2017 Dec 13;2017:
pubmed: 29237662
J Clin Ultrasound. 1996 Nov-Dec;24(9):513-7
pubmed: 8906483
Obstet Gynecol. 2015 Jan;125(1):70-78
pubmed: 25560107
Obstet Gynecol. 1990 Mar;75(3 Pt 2):498-501
pubmed: 2304722
Rural Remote Health. 2008 Oct-Dec;8(4):1087
pubmed: 19053177
Medicina (Kaunas). 2020 Nov 30;56(12):
pubmed: 33266145
J Am Board Fam Pract. 1990 Apr-Jun;3(2):125-8
pubmed: 2185607
BMC Pregnancy Childbirth. 2018 Nov 19;18(1):448
pubmed: 30453918
Hum Reprod. 1999 May;14(5):1372-4
pubmed: 10325296
BMC Pregnancy Childbirth. 2021 Jan 18;21(1):61
pubmed: 33461507
Am J Obstet Gynecol. 1986 Aug;155(2):396-7
pubmed: 3740165
Am J Obstet Gynecol. 1972 Jul 15;113(6):812-3
pubmed: 4635717
BMC Res Notes. 2016 Jan 19;9:31
pubmed: 26785887
Fertil Steril. 2007 Feb;87(2):417.e9-15
pubmed: 17074353
Fertil Steril. 1996 Jul;66(1):1-12
pubmed: 8752602
Niger J Clin Pract. 2009 Sep;12(3):324-6
pubmed: 19803036
Obstet Gynecol. 1986 Nov;68(5):675-8
pubmed: 3763083
BMC Pregnancy Childbirth. 2017 Jul 26;17(1):243
pubmed: 28747162
Am J Obstet Gynecol. 1983 Jun 1;146(3):323-30
pubmed: 6344638
J Emerg Trauma Shock. 2010 Jul;3(3):304
pubmed: 20930992
J Obstet Gynaecol. 1999 Nov;19(6):677-8
pubmed: 15512441
Taiwan J Obstet Gynecol. 2014 Sep;53(3):401-3
pubmed: 25286800
Eur J Obstet Gynecol Reprod Biol. 1998 Oct;80(2):267-71
pubmed: 9846682
Int J Fertil Steril. 2015 Jul-Sep;9(2):265-7
pubmed: 26246887
Hum Reprod. 1993 Jan;8(1):116-8
pubmed: 8458912