Suryawan Aloysius, Rahardjo Theresia Monica, Suparman Erna, Mahardhika Jeffrey Christian
Department of Obstetrics and Gynecology, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia.
Department of Anesthesia and Intensive Care, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia.
SAGE Open Med Case Rep. 2023 Jun 15;11:2050313X231180757. doi: 10.1177/2050313X231180757. eCollection 2023.
Abdominal pregnancy is the rarest ectopic pregnancies, with an incidence of 1 per 10,000 live births, and life-threatening because the symptoms are not specific and diagnosis is made after abdominal pain, amenorrhea and vaginal bleeding occur. We present a rare case of abdominal pregnancy in a 31-year-old Indonesian woman with severe abdominal pain within 24 hours before hospital admission, accompanied by nausea, vomiting, dizziness and weakness. She felt the pain increasing since the last 2 weeks and limiting her movement. She has a history of a left tubal pregnancy 5 years ago. Ultrasonography examination revealed an ectopic pregnancy, and she was rushed to the operation room for emergency exploratory laparotomy. An abdominal pregnancy was found, located in the right adnexa with excessive fluid in cavum Douglass and a foetus in around 11-12 weeks of gestation accompanied by free fluid in the subdiaphragmatic, subhepatic and pelvic cavity. The surgery was a successful, four units of whole blood were transfused, and the patient was safely discharged from the hospital. The current concept on management of abdominal pregnancy supports immediate surgical intervention with pregnancy termination, as found in this case, because the patient's condition is hemodynamically unstable indicating hemorrhagic shock correlated with massive hemoperitoneum. A prompt diagnosis and good teamwork in treatment plays an important role for such a life-threatening condition to avoid maternal morbidity and mortality in a case of abdominal pregnancy.
腹腔妊娠是最罕见的异位妊娠类型，发生率为每10000例活产中有1例，且危及生命，因为其症状不具特异性，常在腹痛、闭经和阴道出血出现后才得以诊断。我们报告一例罕见的腹腔妊娠病例，患者为一名31岁的印度尼西亚女性，入院前24小时内出现严重腹痛，并伴有恶心、呕吐、头晕和乏力。她自两周前开始感觉疼痛加剧，活动受限。她有5年前左侧输卵管妊娠的病史。超声检查显示为异位妊娠，随后她被紧急送往手术室进行急诊剖腹探查。术中发现腹腔妊娠，位于右侧附件区，Douglas腔有大量积液，妊娠约11 - 12周的胎儿，同时膈下、肝下和盆腔均有游离液体。手术成功，输注了4单位全血，患者安全出院。目前关于腹腔妊娠的治疗观念支持立即进行手术终止妊娠，如此病例所示，因为患者血流动力学不稳定，提示出血性休克与大量腹腔内出血相关。对于这种危及生命的情况，及时诊断和良好的团队协作在治疗中起着重要作用，以避免腹腔妊娠病例中的孕产妇发病和死亡。
