Friday, November 30, 2007

Ectopic survival

I went looking because of a search, and found these cases:

  • Rare baby survives outside womb: Montreal doctor, CBC News Tuesday, August 12, 2003: Dionne Grant, a Jamaican tourist, was in Montreal when she had to go to Sacré-Coeur Hospital for an emergency c-section, performed by Dr. Robert Sabbah, head of obstetrics and gynecology. He said, "When I opened the cavity I quickly discovered that the uterus was not like it was supposed to be. As soon as I explored the abdominal cavity I noticed there were feet in the cavity just floating around. So as fast as I could I took out the baby." The placenta had attached to the top of Dionne's uterus, this providing a good blood supply to the baby.

  • Here is an old medical journal article, ADVANCED EXTRAUTERINE PREGNANCY, Bulletin of the Hong Kong Medical Association, vol. 22, 1970. Case 1 was a 32-year-old mother of one, in 1956. "The extrauterine pregnancy was not diagnosed until 38th week when foetal movements could clearly be seen transmitted through the thin abdominal wall." She had no other symptoms that anything was amiss with her pregnancy. An X-ray showed that the baby was oddly situated, with an abnormally curved spine. She was immediately admitted to the hospital, where a 3,430 gram baby girl was delivered. The omentum (apron of fat covering the intestines) was covering the pregnancy, which seemed to have arisen in the right fallopian tube. There were only minor adhesions within the mother's abdomen. The mother recovered well, and had a successful normal pregnancy the following year. The baby was perfectly healthy.

    Case 2 was a 41-year-old mother of two, who had slight bleeding at 16 weeks, and intermittent pain for four months. She was admitted to the hospital at 27 weeks. Her pain subsided after a week of hospitalization. The fetus could be easily felt through the woman's abdominal wall, as could the empty uterus. The patient refused immediate surgery, hoping to perserve her child's life. She remained hospitalized. At 32 weeks she experienced sudden, acute abdominal pain. She was delivered of a 2,010 gram infant. The placenta had attached to the back wall of her pelvic cavity and the right broad ligament. The sac, placenta, and right fallopian tube and ovary were removed, with minimal blood loss. the mother recovered well. The baby had some facial asymmetry due to the unusual pressures placed on her from being gestated outside the womb.

    Case 3
    was a 33-year-old mother of four, admitted to the hospital at 36 1/2 weeks because of recurring abdominal pain. The fetus was in breach presentation, but attempts to turn the baby by maniuplating it through the abdominal wall were unsuccessful. An X-ray revealed that the baby was lying transversely. The doctors decided to perform a c-section, whereupon they learned that the baby was actually behind the mother's uterus.The baby weighed 2,920 grams. The placenta had attached to the back of the mother's reproductive organs, which were removed. The mother recovered well and the baby was healthy.

    Case 4 wasa 43-year-old mother of 8 who had been having abdominal pain since 12 weeks, and was admitted to the hospital at 26 weeks. Her uterus was displaced by the fetus, which was in her abdomen. Two days after she was admitted, she experienced sudden acute abdominal pain, so doctors performed surgery to remove the baby, a girl weighing 1,040 grams. Blood loss was minimal. The mother recovered well, and the baby had no problems other than prematurity. Sadly, she developed a respiratory infection and died at age 34 days.

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    John Jansen said...

    Wow! Amazing.

    Christina Dunigan said...

    Personally, I'd risk it.

    I"ve also noted something that makes me angry -- Mainstream articles, web sites, and books for laypeople simply assert that ectopic pregnancy is 100% fatal for the fetus, and insist that it's absolutely necessary to immediately end the pregnancy in order to keep the mother from dying as well.

    But medical journals note that "conservative management" is safe for the mother. By "conservative management" they mean watching the woman carefully and only intervening if something goes wrong.

    In most cases, the baby dies without intervention and the mother's body deals with it. In some rare cases, the pregnancy will either have originally attached someplace where the baby can come close enough to term for survival. And in some cases, the embryo will actually reattach in a better posistion, either moving from the tube into the uterus, or out of the tube into the abdomen.

    Knowing this, I know I would risk it and choose "conservative management." And I'm sure I'm not alone in that. But women aren't even being given that option. They're simply told "The baby will die, there's no hope." rather than "The odds are very much stacked against your baby, but in very rare cases they do go to viability. Here are the odds of that, and the risks to you." and letting her choose.

    Anonymous said...

    Wow! I never knew you could try and have the baby if the pregnancy was ectopic!!! Thanks so much for posting this so I can pass it along if I ever need to...

    Christina Dunigan said...

    It is somethign that should only be attenpted under close medical supervision! A ruptured ectopic can become fatal for mom very quickly. Fortunately, if she's being closely monitored, it can also be treated very quickly.

    The odds that the baby will survive are very slim. But I can't be the only one that is willing to risk it.

    Anonymous said...

    You should be aware that all of the cases of survival that you mentioned and indeed all the cases of foetal survival in the case of ectopic pregnancies occur when the foetus attaches inside the abdomen. This is exceedingly rare. I suspect there are no cases of survival of the foetus where it implants in one of the fallopian tubes.

    I have never heard of a foetus migrating from the fallopian tube to the uterus after implantation. I asked an MD friend of mine, who is also Catholic and he thought that was a weird idea. He said perhaps the person who said this is confused because fertilization occurs in the fallopian tube and the cells begin to develop along the way but they normally don't implant there.

    So to all you who think stating ectopic pregnancies lead to death is a misleading lie of the pro-choice movement, be very careful. Less than 2% of ectopic pregnancies are abdominal pregnancies, less than 1% of these abdominal pregnancies survive.

    I could not find a reported case of a baby surviving implantation in the fallopian tubes.

    My own opinion is individuals should be given the tools to make their own moral call in these difficult times. If someone wants to risk their life and try to deliver an abdominal pregnancy, they might be easing their conscious knowing that they did not kill a baby on the pretense that it would not survive.

    But fallopian tube pregnancies are another story. God gave us the ability to deliver a baby from a woman's abdomen when it naturally would have died. He has not shown us how to preserve a baby who implanted in a fallopian tube. However, He has taught us how to preserve the life of a woman who finds herself in this devastating circumstance. We should not be loathe to act quickly to preserve the health and life of a woman to prolong the death of an unfortunate doomed child.

    Also consider the families of these women. Children could lose their mothers because a woman refuses to "give up hope" in the case of a fallopian tube pregnancies. Women can lose their fertility for not acting quickly, preventing new life from being brought into the world.

    I understand why a woman would risk her life to deliver an abdominal pregnancy. 1/100 aren't great odds but they are significant. However, fallopian tube ectopic pregnancies account for 98% of ectopic pregnancies and these are not viable. These unfortunate babies should be treated with respect and mourned. God must have a special place for babies who never have a chance to breathe. But I don't think God expects a woman to risk her own life unnecessarily in these 98% of cases... life should be preserved in the face of death.

    Christina Dunigan said...

    My own opinion is individuals should be given the tools to make their own moral call in these difficult times. If someone wants to risk their life and try to deliver an abdominal pregnancy, they might be easing their conscious knowing that they did not kill a baby on the pretense that it would not survive.


    I can look up the other cite I found, in which they found that with "conservative management" a tubal pregnancy will sometimes -- rarely, but sometimes -- break loose from the tube and reattach in the uterus.

    Very rare. I've never pretended it wasn't.

    I also don't think that the fact that women are told ectopics are 100% fatal for the embryo is some sort of nefarious plot. I think it's just doctors playing it safe, since for them the risk of the patient dying is what they're gonna viscerally latch on to. The loss of the embryo is not anything that's gonna hit home for them.

    As I've said, in any ectopic, I'd want to opt for "conservative care", unless I could find a doctor willing to try some experimental surgery, such as attempting to move the tube into position atop the uterus and perhaps carefully open it before it ruptures, to try to increase the chance of survival. I'd want to risk it. And the cumulative effect of enough women willing to risk it might actually enable pioneering doctors to come up with a surgical strategy that could give some of these embryos a fighting chance without significantly increasing the risk to the mothers.

    Anonymous said...

    I am a 36 year old woman who has suffered 2 ectopic pregnancies. my first one was 8 weeks and the second, just this past OCT. In my first I was never even given an option to know that my baby was still alive inside of me. 12 years later and I knew that there was no chance of survival because my beta HCG was going down by the time I entered the hospital.
    I must say that if I had been given the option of know if my baby was alive I would have opted to try and have it knowing what I know now that I am no long able to have children without more money than I have right now and that being the only chance of my have a child that was biologically mione and my husaband's I would have chosen to try and keep the pregancy.
    There are so many that would disagree with me but most of those people have children, and in most cases have never suffered the loss of a child. Even if it meant that I was only able to hold my child for a moment I would have risked it.

    Christina Dunigan said...

    I'm sorry for your losses, anon.

    Too many people take the attitude somehow that if it's inevitable, it's easy to just brush off.

    Anonymous said...

    Thanks Granny,

    How true, and I don't think that even now I am over it or that the pain is any less. I think that I just have learned how to live with it although I am haunted on a daily basis.

    I truly believe that if there is hope for survival, I feel like that we as the mother should be given the choice. The right to decide. If I were to feel like there were no chance I feel like I am old enough and educated enough, that if given the information I could make a decision that I could live with. I just feel like everyone can say that they are sorry and how sad, but no one really knows the torture of having someone else growing inside of you and not being able to help your baby live. I would rather have had natural losses at least the I would know that there was a chance for me to have children.

    Every loss is a loss, no matter how short or long you carry a child. I just wish that there were more information about ectopics and some research on why they happen, and how they can be prevented and even more on how to save those babies that are ectopic. Truly they may be the only chance for some women to ever be mothers.

    Anonymous said...

    I have yet to hear of a doctor try to move an early ectopic, even if it means sacraficing the tube (likely ruined anyway). One doctor one day will be very famous :) For early caught EP with good levels of hormone: Imagine if you cut the tube on the side away from the uterus, stretched the opening to the uterus and very carefully moved the tube inside (try it with a baloon and a piece of gum stuck in the neck). With today's laproscopy technology, even sealing off open blood vessels from inside the uterus could be done. Hormonal treatment might be necessary especially if the uterus is spotting.

    Never say never, and miracles DO happen. I've seen a TE fistula birth defect disappear in my preemie daughter with prayer. Please do try to stay safe especially if you have children who love you. God bless all mothers, including ones whose babies live in heaven.

    Christina Dunigan said...

    They'll start trying it when women start demanding it!

    But to free women up to demand it means first getting rid of the idea that it's totally impossible for a fetus to survive an ectopic pregnancy.

    Anonymous said...

    An older email friend of mine said a friend of hers had an ectopic baby to survive -- she said that the doctor somehow "blew" the baby out of the tube into the uterus, where it then had enough room to grow without rupturing the fallopian tube. Not sure how it was done...

    There's also the story you linked to some time ago about the baby that grew in the woman's ovary -- if there was a good enough blood supply to support the baby there, why not in the tube itself, assuming there was room for the baby. It is my understanding that it is the growing fetus that ruptures the fallopian tube, and not necessarily the growing demands of the baby via the placenta that causes the problem.

    There is also this story of a woman who had intra-uterine twins, and a third baby growing outside her uterus! Fortunately, by the time they discovered the extra-uterine triplet, the babies were viable. I'm assuming if they discovered the ectopic pregnancy any earlier, the baby would have been "selectively reduced". As it is, the children are all perfectly fine!


    Christina Dunigan said...

    Kathy, "blowing" the embryo anywhere would be a poor choice of words even if the ploy was successful, since sudden introduction of air in to the uterus would bring a high risk of a fatal air embolism. Maybe he pushed it, or flushed it with fluid? Could you ask the friend to ask the friend if her doctor wrote up the case or would be willing to just write a quick letter describing it? I'd read that sometimes they will migrate to a better location -- and the fallopian tube does have some mechanisms that try to move the contents toward the uterus.

    I read about the triplets, too. That was pretty amazing.

    Anonymous said...

    ectopic pregnancy....i had 2...lost both my tubes. removing an attached embryo from the fallopian tube in any manner is killing the embryo would sever the blood vessels and cause internal bleeding. i somehow am pregnant now without tubes...miracles do actually happen. it was only 6 weeks ago i had my ectopic and 5 weeks ago i had negative tests. yesterday i had positive tests. now the question is is it abdominal or interuterine.

    Christina Dunigan said...

    Prayers for you and your baby, anon.