A case of advanced abdominal pregnancy.
A case of advanced abdominal pregnancy is described, with survival of both the mother and a normal infant. Reasons for the failure to establish the correct preoperative diagnosis are discussed.
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A case of advanced abdominal pregnancy is described, with survival of both the mother and a normal infant. Reasons for the failure to establish the correct preoperative diagnosis are discussed.
Two cases of advanced abdominal pregnancy have been reviewed and two live babies have been delivered. Emphasis has been given to suggestive clinical features which may help in the pre-operative diagnosis of this rare condition.
The ultrasound diagnosis of abdominal pregnancy continues to be difficult in spite of recent advances in ultrasound technology. The principal impediment is a low suspicion for the diagnosis because of its relatively asymptomatic nature and the lack of specificity of symptoms when present. In the early days of sonography when static B-mode scanning was used, a "gestalt" diagnosis was suggested, based on one's ability to have an overall perspective of the intrauterine contents. With conversion to exclusive real time imaging and the inherent limitation of the field of view, this "gestalt perception" is no longer possible. It is therefore necessary to reassess our criteria based on this change and determine those that remain reliable for diagnosis.
Abdominal pregnancy is an uncommon occurrence, and diagnosis by conventional means is often difficult. A case is presented in which a 29-week viable abdominal pregnancy was diagnosed by magnetic resonance imaging.
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Abdominal pregnancy is extremely rare, but even more unusual is the prolonged retention of an advanced abdominal pregnancy with lithopedion formation. The presentation of lithopedion as an ovarian tumor without a symptom has not been reported in Korea. A 63-yr-old, gravida 2, para 1, woman was referred to us with an abdominal mass. Pelvic examination revealed normal postmenopausal uterus and a fetal head-sized movable hard mass in the lower abdomen. The computed tomographic scan showed a densely echogenic mass of 10-cm in diameter as an ovarian neoplasm. Laparotomy disclosed a lithopedion, of which the bones and cartilages were well preserved. There have been controversies on the treatment of lithopedion. Although some cases are stable for a long time, the morbidity increases when the operation is performed in an elderly patient. So we believe that the surgical intervention should be done as soon as possible after thorough consideration of the morbidity and the risk.
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We report on an abdominal pregnancy that presented as a missed abortion at 16 weeks' gestation and review the literature on the management of abdominal pregnancy. The clinical presentation of abdominal pregnancy varies, and the diagnosis depends on a high index of suspicion. Ultrasonography is useful for early diagnosis of the condition. The management depends on the gestation at presentation; for advanced abdominal pregnancy, surgical intervention is recommended. The treatment of the placenta is a matter of controversy. In general, expectant management is suggested. When the placenta is left behind, the use of prophylactic methrotrexate is not advocated. An awareness of abdominal pregnancy is very important for reducing associated morbidity and mortality.
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