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一位 27 岁的巴西女性,曾有左侧输卵管切除术病史,晚期诊断为子宫外腹腔内妊娠,并在 26 周妊娠时活产。

A 27-Year-Old Brazilian Woman with a History of Left Salpingectomy and Late Diagnosis of an Extra-Uterine Intra-Abdominal Pregnancy and Live Birth at 26 Weeks' Gestation.

机构信息

Department of Obstetrics and Gynecology, Hospital General, Caxias do Sul, RS, Brazil.

Department of Medicine, University of Caxias do Sul, Caxias do Sul, RS, Brazil.

出版信息

Am J Case Rep. 2022 Mar 19;23:e934401. doi: 10.12659/AJCR.934401.

DOI:10.12659/AJCR.934401
PMID:35304434
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8938708/
Abstract

BACKGROUND Abdominal pregnancy is a special type of ectopic pregnancy, characterized by implantation of the embryo in the peritoneal cavity, with tubal, ovarian, and intraligamentary pregnancies excluded, accounting for approximately 1% of all cases. It was first reported in 1708 after an autopsy and since then numerous cases have been reported, with a current incidence of 1: 10 000 to 1: 30 000 pregnancies. CASE REPORT We report the case of a 27-year-old woman, resident of the city of Caxias do Sul, Brazil, with an extra-uterine pregnancy by ultrasound diagnosis at 25 weeks and 1 day of gestational age and a live fetus. CONCLUSIONS Abdominal gestation is a rare type of ectopic pregnancy and is characterized as a life-threatening situation. Its biggest challenge is to make an early diagnosis, since most cases go unnoticed at the ultrasound performed in the first trimester, and when symptomatic, they do not present themselves in a specific way. When necessary, MRI has been shown to greatly elucidate such cases. Moreover, the therapeutic decision also presents some disparities in the literature. Although it is known that open surgery is best option, there are still many doubts regarding whether to perform placental extraction since its removal process can cause abundant bleeding, putting the patient at risk during the surgical procedure, in the same way that its maintenance and the use of drug treatment can also aggravate the patient's clinical picture.

摘要

背景

腹腔妊娠是一种特殊类型的异位妊娠,其特征为胚胎着床于腹腔内,排除输卵管、卵巢和子宫韧带内妊娠,约占所有妊娠的 1%。1708 年首例腹腔妊娠病例在尸检后被报道,此后陆续有病例报告,目前发病率为 1:10000 至 1:30000 次妊娠。

病例报告

我们报告了一例巴西卡西亚斯杜苏尔市 27 岁女性病例,其经超声诊断在妊娠 25 周加 1 天时为宫外孕,且胎儿存活。

结论

腹腔妊娠是一种罕见的异位妊娠类型,其特征为危及生命。最大的挑战是早期诊断,因为大多数病例在孕早期的超声检查中未被发现,而当出现症状时,其表现并不特异。在必要时,磁共振成像(MRI)已被证明可以极大地阐明这些病例。此外,治疗决策在文献中也存在一些差异。虽然开腹手术是最佳选择已被公认,但对于是否进行胎盘取出仍存在许多疑问,因为胎盘的取出过程可能导致大量出血,使患者在手术过程中面临风险,同样地,保留胎盘和使用药物治疗也可能加重患者的临床症状。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/28f6b8313f06/amjcaserep-23-e934401-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/c161575564ad/amjcaserep-23-e934401-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/dcda134187e6/amjcaserep-23-e934401-g002.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/55438e2fb5a6/amjcaserep-23-e934401-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/f42eb898573b/amjcaserep-23-e934401-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/731428d233a5/amjcaserep-23-e934401-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/28f6b8313f06/amjcaserep-23-e934401-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/c161575564ad/amjcaserep-23-e934401-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/dcda134187e6/amjcaserep-23-e934401-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/5686122b3b82/amjcaserep-23-e934401-g003.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/614cd04152cb/amjcaserep-23-e934401-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/55438e2fb5a6/amjcaserep-23-e934401-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/f42eb898573b/amjcaserep-23-e934401-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/731428d233a5/amjcaserep-23-e934401-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2cb7/8938708/28f6b8313f06/amjcaserep-23-e934401-g009.jpg

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本文引用的文献

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Abdominal ectopic pregnancy with implantation on the rectum.直肠着床的腹部异位妊娠。
Ulster Med J. 2020 Sep;89(2):101-102. Epub 2020 Oct 21.
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Early primary abdominal pregnancy: Diagnosis and management. A case report.原发性早期腹腔妊娠:诊断与处理。病例报告。
Int J Surg Case Rep. 2020;73:303-306. doi: 10.1016/j.ijscr.2020.07.048. Epub 2020 Jul 23.
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Abdominal pregnancy with a healthy newborn: a new case.一例伴有健康新生儿的腹腔妊娠:一个新病例。
Pan Afr Med J. 2019 Sep 16;34:35. doi: 10.11604/pamj.2019.34.35.20169. eCollection 2019.
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Diagnosis of abdominal pregnancy still a challenge in low resource settings: a case report on advanced abdominal pregnancy at a tertiary facility in Western Kenya.在资源匮乏地区,腹腔妊娠的诊断仍然是一项挑战:肯尼亚西部一家三级医疗机构关于晚期腹腔妊娠的病例报告
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Full-Term Live Secondary Abdominal Pregnancy: A Rare Case Report.足月活产继发性腹腔妊娠:一例罕见病例报告
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Secondary abdominal pregnancy.继发性腹腔妊娠
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