Yacouba Maimouna Chaibou, Diouaga Hamidou Soumana, Oumara Maina, Garba Madeleine Ramatou, Nayama Madi
Department of Obstetrics and Gynecology, Issaka Gazobi Maternity Hospital in Niamey, Niamey, Niger.
BMC Pregnancy Childbirth. 2025 May 23;25(1):604. doi: 10.1186/s12884-025-07730-w.
Advanced abdominal pregnancy is a rare form of ectopic pregnancy. It is rarely diagnosed especially in low-income countries and associated with very high fetal and maternal morbidity and mortality. The management of advanced abdominal pregnancy is based on surgical procedure. Laparotomy was chosen to be better than laparoscopic surgery because of the risk of perioperative haemorrhage, which can be uncontrollable from the implantation site. Uterine prolapse during pregnancy is rare. The etiology is multifactorial. We report this association to discuss difficulties in the management of these two pathologies in areas where health services are unavailable or utilized poorly.
A 25-year-old woman was referred to our maternity ward for uterine prolapse and pregnancy. On examination, the cervix protruded and edematous beyond the introitus (Stade IV of the POP-Q classification). She had no prenatal consultation and no history of surgery or vaginal delivery complications. The obstetric ultrasound revealed an empty uterus and an abdominal pregnancy at 32 weeks and the placenta localization was unclear. An urgent laparotomy was performed, and we discovered the foetus in the abdominal cavity. The placenta was attached to the right ovary and large ligament. We successfully extracted the foetus and placenta. The newborn presented ectodactylia and club varus equinus. He developed respiratory distress after 12 h and died. Before her was discharged from the hospital, she requested sterilization and total hysterectomy was scheduled after 3 months.
The association between advanced abdominal pregnancy and uterine prolapse is exceptional. This phenomenon can be observed in developing countries because of poor prenatal follow-up. Management is based on urgent laparotomy for abdominal pregnancy and hysterectomy for uterine prolapse for women who have completed their family's life.
晚期腹腔妊娠是一种罕见的异位妊娠形式。它很少被诊断出来，尤其是在低收入国家，并且与极高的胎儿和孕产妇发病率及死亡率相关。晚期腹腔妊娠的治疗基于外科手术。由于围手术期出血风险，开腹手术被认为比腹腔镜手术更好，因为出血可能来自植入部位且难以控制。妊娠期子宫脱垂很少见。其病因是多因素的。我们报告这种关联，以讨论在卫生服务无法获得或利用不佳的地区，这两种病症治疗中的困难。
一名25岁女性因子宫脱垂和妊娠被转诊至我们的产科病房。检查时，宫颈突出且水肿，超出阴道口（盆腔器官脱垂定量分期系统IV期）。她没有进行过产前检查，也没有手术史或阴道分娩并发症史。产科超声显示子宫内为空，妊娠32周，腹腔妊娠，胎盘位置不明。紧急进行了开腹手术，我们在腹腔中发现了胎儿。胎盘附着于右卵巢和阔韧带。我们成功取出了胎儿和胎盘。新生儿出现多指畸形和马蹄内翻足。他在12小时后出现呼吸窘迫并死亡。在她出院前，她要求绝育，计划在3个月后进行全子宫切除术。
晚期腹腔妊娠与子宫脱垂的关联非常罕见。由于产前随访不佳，这种现象在发展中国家可能会被观察到。对于已完成生育的女性，治疗方法是针对腹腔妊娠进行紧急开腹手术，针对子宫脱垂进行子宫切除术。
