Pritze W, Kroesen A, Ebert A D
Frauenklinik und Poliklinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Freie Universität Berlin.
Zentralbl Gynakol. 2003 Dec;125(12):522-4. doi: 10.1055/s-2003-44814.
Early abortion of a abdominal pregnancy is a rare gynecological emergency occurring in 1/10(4) pregnancies in the US. In unconscious patients in the reproductive age this differential diagnosis has to be taken in mind for the choice of the therapeutic management.
A 30- year-old woman (II-gravida, I-para) suffering for about 18 hours from "upper abdominal pain" was found in somnolent and in reduced conditions by her relatives. Unconscious and with all signs of a hemorrhagic shock, she was transferred to the emergency department of the UKBF. After stabilization of circulation, a diagnostic laparoscopy has been performed with the finding of about 2000 ml of coagulated and fresh blood, but without the confirmation of a extrauterine pregnancy (EUP): the small pelvis and his organs were without any signs of EUP. The laparoscopic approach has been changed into a secondary median laparotomy. After exclusion of other reasons for a intraabdominal bleeding (such as spleen rupture or gastrointestinal bleeding), and the complete removal of all intraabdominal blood clots, a embryo, his placenta and the place of placental insertion has been found in the mesenterium jejuni. The surgical procedure was finished in the usual way. The postoperative healing process was uncomplicated.
Our case did meet Veits criteria of a abdominal pregnancy: intact embryo, no contact between placenta and fallopian tubes or ovaries, resp., but definitive insertion of the placenta in the distant peritoneum. In woman in their reproductive age suffering from intraabdominal bleeding, the exclusion of a ectopic pregnancy is essential. In the case of a vital emergency, and because of suboptimal management conditions (without a sufficient patients history, lack of vaginal sonography, instable circulation because of delayed diagnosis), excluding the opportunity of a laparoscopic exploration, the correct diagnosis of the early abortion of a abdominal pregnancy has to be made by open surgery.
腹腔妊娠早期流产是一种罕见的妇科急症，在美国每10⁴次妊娠中发生1例。对于育龄期昏迷患者，在选择治疗方案时必须考虑到这种鉴别诊断。
一名30岁女性（孕2产1）因“上腹部疼痛”约18小时，被亲属发现处于嗜睡且状况不佳状态。她昏迷且有失血性休克的所有体征，被转至英国BF医院急诊科。循环稳定后，进行了诊断性腹腔镜检查，发现约2000毫升凝血和新鲜血液，但未确诊宫外孕（EUP）：盆腔及其器官未发现任何宫外孕迹象。腹腔镜手术改为经腹正中二次剖腹手术。排除腹腔内出血的其他原因（如脾破裂或胃肠道出血），并彻底清除所有腹腔内血凝块后，在空肠系膜中发现了一个胚胎、其胎盘及胎盘附着部位。手术按常规方式完成。术后愈合过程顺利。
我们的病例符合腹腔妊娠的Veits标准：胚胎完整，胎盘与输卵管或卵巢无接触，但胎盘确实附着于远处腹膜。对于育龄期腹腔内出血的女性，排除宫外孕至关重要。在紧急情况下，由于管理条件欠佳（患者病史不足、缺乏阴道超声检查、因诊断延迟导致循环不稳定），排除腹腔镜探查的机会，必须通过开放手术正确诊断腹腔妊娠早期流产。
