Abdominal pregnancy

Abdominal pregnancy is a rarity that only a few gynaecologists will encounter during their professional career. Most abdominal pregnancies are the result of reimplantation of ruptured undiagnosed tubal ectopic pregnancies. With the increasing accuracy of first-trimester transvaginal scanning it is likely the prevalence of advanced abdominal pregnancy will decrease even further in the future. The clinical and ultrasound features of an early abdominal pregnancy are very similar to tubal ectopic pregnancies. However, viable abdominal pregnancies, which progress beyond the first trimester, are typically missed on routine transabdominal scanning. Abdominal pregnancy should be suspected in women with persistent abdominal pain later in pregnancy and in those who complain of painful fetal movements. In abdominal pregnancy it is often difficult to obtain clear images of the fetus due to overlying bowel loops, there is often evidence of oligohydramnios and early intrauter-ine growth resriction (IUGR). Perinatal mortality is high (>40%) and the incidence of fetal malformations is also increased [56].

In women with a clinical suspicion of abdominal pregnancy a transvaginal scan should be performed to assess the uterus and establish the continuity between the cervical canal, uterine cavity and gestational sac. If pregnancy is clearly outside the uterine cavity the differential diagnosis includes abdominal pregnancy and pregnancy in an atretic non-communicating cornu of a unicornuate uterus. The visualization of both interstitial portions of the tubes favours the diagnosis of abdominal pregnancy.

Treatment of abdominal pregnancy is surgical. The timing of the intervention depends on clinical signs and patient's symptoms. In advanced abdominal pregnancies accompanied by normal fetal development diagnosed in the late second trimester termination of pregnancy may be delayed for a few weeks until the fetus reaches viability. At surgery the gestational sac should be opened carefully avoiding disruption of the placenta. The fetus should be removed, the cord cut short and the placenta should be left in situ [57]. Any attempt to remove the placenta may result in massive uncontrollable haemorrhage. Adjuvant treatment with methotrexate is not necessary and the residual placental tissue will absorb slowly over a period of many months, sometimes a few years. The placental tissue left in situ may become infected leading to the formation of a pelvic abscess, which may require drainage.

Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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