Tuesday, August 05, 2008

More ectopic survivors

I found these as a result of checking the other results for searches that led to my blog. I'm going to have to do a page over at RealChoice about it, building on my original ectopic survival blog post.

As is generally the case in ectopic cases in which there is a live birth, these are abdominal pregnancies.

  • Live abdominal pregnancy presenting as massive rectal bleeding: "A case of massive rectal bleeding resulting from the placental attachment of an abdominal pregnancy to the sigmoid colon is reported. Both mother and infant survived this rare complication which should be considered when abdominal colic and major gastrointestinal haemorrhage occur in a pregnant patient."

  • Abdominal pregnancies, Primary Surgery: Volume One: Non-trauma, Chapter 8. The surgery of pregnancy: Covers a case of survival, with recommendations for management.

  • Massive hemorrhage in a previously undiagnosed abdominal pregnancy presenting for elective Cesarean delivery: Not sure if this is a new case or not.

  • Abdominal pregnancies in Sweden resulting in live infants 1970-81: The site is just a cite for an article in Swedish, leaving me to wonder how many infants were born alive after abdominal gestation just in Sweden in those 11 years.

  • Full-term viable abdominal pregnancy: a case report and review: A full-term abdominal pregnancy culminating in the birth of a live healthy baby by laparotomy is described.

    As I said before, I'm going to do more research on this and get it up on the main RealChoice page so I can more readily link to it. Please contribute more cases as you find them.

    I get the sad feeling this baby didn't get a chance to survive, the page is remarkable. An ultrasonographer presents video ultrasound of an embryo in an ectopic, including the "cardiac activity". For those of you wondering why we get all in a tizzy about wanting to save these "pregnancies". Answer: They're tiny children, that's why.


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  • 10 comments:

    Anonymous said...

    I wonder, Ive read that women that have had a partial hysterectomy are able to get pregnant if their fallopian tubes and ovaries are left intact, typically with a tubal pregnancy, has there been any reports of those ectopic pregnancies being abdominal and ending with a live birth?

    GrannyGrump said...

    I've posted all I can find, anon. I'd suggest going to a university library and asking a reference librarian to help you do a search of medical journals.

    wsforten said...

    I have cataloged well over 400 ectopic pregnancies that have resulted in live births. A partial listing can be found at: http://www.personhoodinitiative.com/successful-ectopic-pregnancies.html.

    I've also written an article on the issue of ectopic pregnancy and abortion, and you can read that article at: http://www.personhoodinitiative.com/ectopic-personhood.html.

    Feel free to use any of my information for your blog.

    Christina Dunigan said...

    I'll convert those URLs into links:

    Successful Ectopic Pregnancies

    Ectopic Pregnancies and Abortion

    Christina Dunigan said...

    More studies addresseng "expectant management" i.e. monitoring the mother and allowing nature to take its course:

    Expectant management of ectopic pregnancy -- I believe that they qualify successful expectant management as the mother not needing medical intervention, not fetal survival.

    Expectant management -- "More than half of all ectopic pregnancies will end naturally without the need for medical or surgical treatment."

    Expectant Management of Ectopic Pregnancy :
    Analysis of Four Cases
    -- "Before the advent of surgical therapy for management
    of ectopic pregnancy, it was noted that ectopic pregnancy
    was not uniformly fatal. It has been assumed for decades
    that spontaneous resolution of ectopic gestation occurs."

    Christina Dunigan said...

    More:

    -- "Results: Expectant management was studied in 83 patients, representing 26% of all ectopic pregnancies during a 2-year period. In 57 patients (69%), spontaneous resolution occurred, corresponding to 18% of all ectopic pregnancies. Laparoscopy was performed in 26 because of clinical symptoms or a rise in hCG level after expectant management for 1-18 days. One patient had a tubal rupture requiring tubal resection by laparoscopy. No serious complications occurred. With increasing experience, the rate of expectant management and spontaneous resolution increased during study period."

    Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis. -- "A total of 107/179 (59.8%) tubal ectopics were considered suitable for expectant management. Ectopic pregnancy resolved spontaneously in 75/107 (70%) women, which was 41.9% of the total number of tubal ectopics."

    Christina Dunigan said...

    I added "migration" to my Google search:


    Ectopic Pregnancy
    -- "Ovarian and abdominal ectopic pregnancies are rare. When studied at real-time, ovarian ectopic pregnancies move with respect to the ovary, not separately. Abdominal ectopic pregnancy typically develops in the ligaments of the ovary. It can then obtain blood supply from the omentum and abdominal organs. At times these pregnancies migrate out of the pelvis and are seen in the upper abdomen. Sonographically the pregnancy is seen separate from the uterus, adnexa, and ovaries. Treatment is by means of laparotomy or laparoscopy (Fig 7) (39). While abdominal pregnancy can result in a life-threatening emergency, especially when diagnosed late in gestation, it can also result in a live birth by means of laparotomy."

    Christina Dunigan said...

    Here's a missing link:

    "Results: Expectant management was studied in 83 patients, representing 26% of all ectopic pregnancies during a 2-year period. In 57 patients (69%), spontaneous resolution occurred, corresponding to 18% of all ectopic pregnancies. Laparoscopy was performed in 26 because of clinical symptoms or a rise in hCG level after expectant management for 1-18 days. One patient had a tubal rupture requiring tubal resection by laparoscopy. No serious complications occurred. With increasing experience, the rate of expectant management and spontaneous resolution increased during study period."

    Christina Dunigan said...

    Ectopic Pregnancy "Rarely, reimplantation of the conceptus occurs in another abdominal structure leads to secondary abdominal pregnancy."

    Christina Dunigan said...

    This one is particularly interesting:

    Embryo Transfer In Vivo --

    "Advanced ectopic pregnancies that were secondary to tubal pregnancy or from a rent in the uterus have progressed through the four phases
    described by Mukhergee. In the 20 patients who had the symptoms, reimplantation occurred from
    five weeks to ten weeks. This showed chorionic tissue to be very adaptable in relocating on various sites. The new placental sites comprise the peritoneum, fallopian tube, ovary, omentum, intestinal serosa, myometrium, and endometrium
    with the fetus outside the uterus.

    Twenty-eight weeks gestational age, or longer, was used as an index to demonstrate the presence
    of a good environment to support a growing fetus. All 44 patients were reviewed to see how many
    progressed to 28 weeks or more.

    The author did not use a viable infant at birth as a criterion for reimplantation because many cases
    had been misdiagnosed earlier. If earlier correct diagnoses had been made, an increased number of live infants would have been delivered.

    ....

    Our records on 20 patients showed that these transfers occurred much later. Our cases showed that a viable embryo and trophoblastic
    tissue will reimplant and continue to grow if there is a functional corpus luteum, adequate blood supply to the new placenta site, and a suitable environment which varied from uterus, fallopian
    tube, intestine, and peritoneum.

    ....

    This review of cases questions the absolute value of implantation in the endometrial cavity."