Gupta Pratiksha, Sehgal Alka, Huria Anju, Mehra Reeti
Department of Obstetrics and Gynecology, Government Medical College and Hospital Sector 32B Chandigarh, 160030 India.
J Med Case Rep. 2009 Aug 7;3:7382. doi: 10.4076/1752-1947-3-7382.
Abdominal pregnancy is extremely rare and has historically been defined as an implantation in the peritoneal cavity, exclusive of tubal, ovarian or intraligamentary pregnancy.
Three cases are reported. All came from a lower middle-income group and all of them were subjected to surgery. The first patient was a 30-year-old woman, who was pregnant for the fourth time, who presented at 16 weeks with an abdominal pregnancy. She was admitted with constant abdominal pain and retention of urine. She was hemodynamically stable and was administered a pre-operative intramuscular injection of methotrexate. During laparotomy she had only minor blood loss, the major part of the placenta was removed easily and she did not require any blood transfusion. Serum beta human chorionic gonadotrophin values and ultrasound follow-up revealed a normal study four weeks after surgery. The second patient was a 26-year-old woman, pregnant for the third time, admitted at 14 weeks with an abdominal pregnancy with hemoperitoneum, and the third patient was a 24-year-old woman, pregnant for the first time, who presented at 36 weeks gestation. She was only diagnosed as having an abdominal pregnancy during surgery, experienced excessive blood loss and required a longer hospital stay.
We hypothesize that treatment with pre-operative systemic methotrexate with subsequent laparotomy for removal of the fetus and placenta may minimize potential blood loss, and would be a reasonable approach in the care of a patient with an abdominal pregnancy with placental implantation to the abdominal viscera and blood vessels. This treatment option should be considered in the management of this potentially life-threatening condition. During surgery, if the placenta is attached to vital organs it should be left behind. Early diagnosis can help in reducing associated maternal morbidity and mortality.
腹腔妊娠极为罕见，历史上被定义为胚胎着床于腹膜腔，不包括输卵管、卵巢或阔韧带内妊娠。
报告了三例病例。所有病例均来自中低收入群体，且均接受了手术治疗。首例患者为一名30岁女性，第四次怀孕，孕16周时诊断为腹腔妊娠。她因持续性腹痛和尿潴留入院。血流动力学稳定，术前给予甲氨蝶呤肌肉注射。剖腹手术中失血较少，大部分胎盘易于切除，无需输血。术后四周血清β-人绒毛膜促性腺激素值及超声随访显示结果正常。第二例患者为一名26岁女性，第三次怀孕，孕14周时因腹腔妊娠合并腹腔积血入院，第三例患者为一名24岁女性，首次怀孕，孕36周时就诊。她在手术中才被诊断为腹腔妊娠，术中失血过多，住院时间较长。
我们推测，术前全身应用甲氨蝶呤，随后行剖腹手术切除胎儿及胎盘，可使潜在失血量降至最低，对于胎盘着床于腹腔脏器和血管的腹腔妊娠患者而言，是一种合理的治疗方法。在处理这种可能危及生命的情况时应考虑这一治疗选择。手术中，如果胎盘附着于重要器官，应予以保留。早期诊断有助于降低孕产妇相关发病率和死亡率。
