Tuesday, March 07, 2006

Rare birth: Abdominal pregnancy

American Family Physician: Abdominal pregnancy
A 22-year-old primiparous woman was admitted to the hospital in labor at 38 weeks of gestation, with a diagnosis of transverse lie. She had a history of vaginal bleeding in the first trimester but no other complaints. Apart from the transverse lie, physical findings were normal. Fundal height was 38 cm. The cervix was dilated 2 cm but not effaced, and no presenting part was palpated. Because of the transverse lie, the patient was taken to surgery for cesarean delivery. When the abdomen was opened, a gestational sac was found superior to the uterus. The sac was incised and a female infant, weighing 2.6 kg (5 lb, 12 oz) was delivered. The infant had Apgar scores of 2 and 6.

The placenta was attached to the right superior margin of the uterus, the right tube and ovary, and the broad ligament. The placenta was removed because of massive hemorrhage, with blood loss of 3,900 mL. The postoperative course was complicated by a transfusion reaction. The mother and the normal infant were discharged 16 days after delivery.

I'm looking into abdominal and tubal pregnancies right now, since they're such a common cause of prenatal death, to see what, if anything, is being done to provide a life-preserving option for women who want to try to save their unborn children if possible.

UPDATE I've found a number of cases, which I wrote up in this article. The most amazing thing I've learned is that apparently sometimes an embryo that lodges in the fallopian tube will break loose and re-implant in the abdomen. These pregnancies will sometimes continue to viability.

With this new information, were I to face an ectopic pregnancy I'd certainly want to at least give the embryo a chance to drift out and re-implant someplace safer. Or maybe even have a doctor shift the tube to a better location and carefully open it to prevent rupture and give the embryo room to grow. Okay, it's a long shot, but ... What about others out there?

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