[HORMONAL SECRETION IN ADVANCED ABDOMINAL PREGNANCY].
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Three patients with abdominal pregnancy have been treated at Stanford University Hospital in recent years. Common to each was surgically uncontrolled hemorrhage for which circumferential pneumatic compression (supplied by a medical antigravity suit) was used to stop the bleeding. In each patient, the hemostatic effect of treatment was dramatic. In published accounts of the use of the garment in other severely hemorrhaging patients, the effects have been similarly dramatic and equally successful. These observations lead to a compelling consideration in regard to optimum management of patients with abdominal pregnancy. If our experience is confirmed by others, optimum management in abdominal pregnancy hereafter should regularly and routinely include removal of the placenta at the primary operation. This approach would anticipate use of the medical antigravity suit to provide hemostasis if surgically uncontrollable bleeding is encountered. Theoretically, the complications and long-term morbidity associated with retention of the placenta would be eliminated by this means while the previous disadvantage of placental removal, the potential for exsanguinating hemorrhage, would be circumvented.
Three consecutive ectopic pregnancies were diagnosed in one patient. Two pregnancies (one following IVF-ET) proceeded as abdominal pregnancies till the third trimester of pregnancy. Neither abdominal pregnancies had been diagnosed prior to surgery.
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Two cases of Abdominal pregnancy are reported: one from the Castle Street Hospital for Women, Colombo, Sri-Lanka and the other from the Queen Elizabeth Hospital, Barbados, West Indies. The clinical manifestations, diagnosis and management are described. A review of the literature is presented.
A case of abdominal pregnancy was followed until 34 weeks' gestation, when rupture of the amniotic sac was noted. A live and anatomically normal female weighing 1400 g was delivered by laparotomy and the placenta was left in place. Color Doppler imaging and measurement of serum beta-human chorionic gonadotropin (beta-hCG) were successfully used to follow the placental involution after delivery. A progressive increase in the resistance index in the utero-ovarian and subplacental vessels was observed while beta-hCG disappeared 45 days after laparotomy. The mother and baby left hospital 20 days after delivery and are both doing well.
In a successful abdominal pregnancy, urinary oestriol levels were about the fifth centile, but other hormone concentrations suggested that placental function was normal until 32 weeks gestation. After that, plasma oestrogen concentrations levelled off and plasma placental lactogen concentrations declined. Pre-eclampsia developed at 34 weeks and necessitated the delivery at 36 weeks and 2 days of a live normal female infant by laparotomy. The placenta was not removed. All hormone levels fell rapidly during the first weeks of the puerperium and then more slowly during the next six weeks to non-pregnancy levels. Plasma progesterone, urinary pregnanediol, and plasma oestradiol were the slowest to return to non-pregnant levels.