Advanced extrauterine pregnancy: diagnostic and therapeutic challenges

Objective The objective of the study was to identify women with advanced extrauterine pregnancy, specifically assessing the problems encountered with their diagnosis and management, preoperative evaluation, and surgical removal. Study Design This was a case series including women diagnosed with an e...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2008-03, Vol.198 (3), p.297.e1-297.e7
Main Authors: Worley, Kevin C., MD, Hnat, Michael D., DO, Cunningham, F. Gary, MD
Format: Article
Language:English
Subjects:
abdominal pregnancy
Adult
advanced ectopic pregnancy
advanced extrauterine pregnancy
Biological and medical sciences
Female
Gynecology. Andrology. Obstetrics
Humans
Medical sciences
Obstetrics and Gynecology
Pregnancy
Pregnancy Trimester, Second
Pregnancy, Ectopic - diagnosis
Pregnancy, Ectopic - surgery
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Summary:Objective The objective of the study was to identify women with advanced extrauterine pregnancy, specifically assessing the problems encountered with their diagnosis and management, preoperative evaluation, and surgical removal. Study Design This was a case series including women diagnosed with an extrauterine pregnancy of 18 weeks’ gestation or greater at our institution from 1980 to 2005. Results We identified 10 women with advanced extrauterine pregnancies during the study period. Diagnosis was not optimal, and only 6 were discovered preoperatively. Despite the fact that only 3 of 10 women met diagnostic criteria for an abdominal pregnancy, surgical dissection was universally difficult, and hemorrhage was common with 9 of 10 patients requiring blood transfusions. In 2 women, the placenta was left in situ, and both developed serious complications. All 5 viable fetuses survived, but their courses were long and complicated. Conclusion Irrespective of placental implantation site, an advanced extrauterine pregnancy is a serious condition. The currently accepted definition of abdominal pregnancy is too exclusive.
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2007.09.044