Broad ligament twin pregnancy following in-vitro fertilization.
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We report the first case of an ectopic twin pregnancy in the broad ligament following in-vitro fertilization and embryo transfer in a patient with a previous ipsilateral (left) salpingo-oophorectomy. The previous surgery was for endometriosis. We discuss the possible contribution of the embryo transfer technique, limitations of preventive measures and importance of transvaginal ultrasound in establishing the diagnosis. (+info)
The forgotten child--a case of heterotopic, intra-abdominal and intrauterine pregnancy carried to term.
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Heterotopic pregnancies are estimated to be less frequent than one in 30,000 if no assisted reproduction technologies are performed. Here we report a case which occurred in Tanzania. An abdominal pregnancy at term was first misdiagnosed as an ovarian tumour and diagnosed on the first post-partum day of the intrauterine fetus, which was delivered spontaneously. The abdominal pregnancy was then treated by laparotomy and removal of the placenta. The fetus was alive and healthy. The follow-up of the twins was normal. (+info)
Successful non-surgical management of a heterotopic abdominal pregnancy following embryo transfer with cryopreserved-thawed embryos.
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Heterotopic pregnancy is an increasingly common complication of assisted reproductive technology. Abdominal pregnancy is a rare and life-threatening form of ectopic pregnancy that can present as the extrauterine portion of a heterotopic pregnancy. We present the case of a cryopreserved-thawed embryo transfer that resulted in a simultaneous intrauterine and abdominal pregnancy first recognized at 10 weeks gestation. Ultrasound-guided transvaginal injection of potassium chloride into the abdominal pregnancy resulted in asystole and spontaneous resorption of the ectopic fetus, while the intrauterine pregnancy continued and resulted in a liveborn vaginal delivery at full term. Selective embryo reduction using a non-surgical approach in a haemodynamically stable patient can therefore be considered in the management of heterotopic abdominal pregnancy if diagnosed relatively early. (+info)
Primary peritoneal pregnancy implanted on the uterosacral ligament: a case report.
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Peritoneal pregnancies are classified as primary and secondary. Primary implantation on the peritoneum is extremely rare in extrauterine pregnancy and is a potentially life-threatening variation of ectopic pregnancy within the peritoneal cavity, representing a grave risk to maternal health. Secondary abdominal pregnancies are by far the most common and result from tubal abortion or rupture, or less often, after uterine rupture with subsequent implantation within abdomen. Early diagnosis and appropriate surgical management, regardless of stage of gestation, appear to be important in achieving good results. We report a case of primary peritoneal pregnancy in a 28-year-old woman, who had severe lower abdominal pain one day before laparotomy for a preoperative diagnosis of ectopic pregnancy. The conceptus was implanted on the left uterosacral ligament. A fresh embryo of approximately 8 weeks' gestation was found in the conceptus. (+info)
Calcified abdominal pregnancy with eighteen years of evolution: case report.
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CONTEXT: The lithopedion (calcified abdominal pregnancy) is a rare phenomenon and there are less than 300 cases reported in the medical literature. CASE REPORT: In this case, a 40 year-old patient had had her only pregnancy 18 years earlier, without medical assistance since then. She came to our hospital with pain and tumoral mass of approximately 20 centimeters in diameter. Complementary examinations (abdominal X-ray, ultrasonography and computerized tomography) demonstrated an extra-uterine abdominal 31-week pregnancy with calcification areas. Exploratory laparotomy was performed, with extirpation of a well-conserved fetus with partially calcified ovular membranes. (+info)
Abdominal pregnancy presenting as a missed abortion at 16 weeks' gestation.
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We report on an abdominal pregnancy that presented as a missed abortion at 16 weeks' gestation and review the literature on the management of abdominal pregnancy. The clinical presentation of abdominal pregnancy varies, and the diagnosis depends on a high index of suspicion. Ultrasonography is useful for early diagnosis of the condition. The management depends on the gestation at presentation; for advanced abdominal pregnancy, surgical intervention is recommended. The treatment of the placenta is a matter of controversy. In general, expectant management is suggested. When the placenta is left behind, the use of prophylactic methrotrexate is not advocated. An awareness of abdominal pregnancy is very important for reducing associated morbidity and mortality. (+info)
Old abdominal pregnancy presenting as an ovarian neoplasm.
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Abdominal pregnancy is extremely rare, but even more unusual is the prolonged retention of an advanced abdominal pregnancy with lithopedion formation. The presentation of lithopedion as an ovarian tumor without a symptom has not been reported in Korea. A 63-yr-old, gravida 2, para 1, woman was referred to us with an abdominal mass. Pelvic examination revealed normal postmenopausal uterus and a fetal head-sized movable hard mass in the lower abdomen. The computed tomographic scan showed a densely echogenic mass of 10-cm in diameter as an ovarian neoplasm. Laparotomy disclosed a lithopedion, of which the bones and cartilages were well preserved. There have been controversies on the treatment of lithopedion. Although some cases are stable for a long time, the morbidity increases when the operation is performed in an elderly patient. So we believe that the surgical intervention should be done as soon as possible after thorough consideration of the morbidity and the risk. (+info)
Uterine artery Doppler patterns in abdominal pregnancy.
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Changes in the uterine artery blood flow waveform during pregnancy have been the subject of several studies and are frequently attributed to trophoblastic invasion of the myometrium. We report on a case of a third-trimester abdominal pregnancy in which we performed Doppler velocimetry of the uterine arteries and observed low-resistance flow and absence of notching bilaterally. During the 29th week of gestation, there was an increase in umbilical artery resistance and a decrease in the middle cerebral artery resistance, so we chose to deliver the baby at that stage. The patient was discharged from hospital 7 days following delivery and the child was discharged having gained the necessary weight. Our findings suggest that modification of the uterine artery waveform may occur independently of trophoblast invasion of the spiral arteries. Other theories that may explain the changes in the uterine artery waveform during pregnancy are discussed. (+info)