Abdominal pregnancy at term. Conservative management. An extremely rare case report

R. Botezatu, A.M. Panaitescu, G. Peltecu, R. Chirilă, N. Gică

Rezumat: The development to term of a pregnancy attached into the abdominal cavity is a rare finding and is associated with an increased risk of maternal and fetal morbidity and mortality. We present a case where an abdominal pregnancy was first discovered at the time of a planned caesarean section for suspected major placenta praevia and transverse lie. After the fetal extraction (2750 grams, Apgar score 6 and 8 at 1 and 5 minutes), the placenta was seen inserted onto the root of the mesentery, the sigmoid colon and mesosigmoid and on the fundus of the uterus. The decision was to leave the placenta in situ after the ligation of the umbilical cord. The postoperative course was uneventful. A magnetic resonance imaging was performed during the hospital stay and three months later, showing the involution of placenta. No complications were recorded during two years of follow- up. When an abdominal pregnancy is unexpectedly encountered at term, the placenta can be left in situ in order to avoid uncontrolled hemorrhage and unwanted lesions to the abdominal organs to which placenta is attached; a planned second stage surgery can then be taken into consideration for its removal in case of complications. In our case, a conservative management was adopted, with close clinical and imaging (MRI, abdominal ultrasound) follow-up and the patient had an uneventful recovery with a gradual involution of the placenta.
Cuvinte cheie: abdominal pregnancy, placenta, ectopic pregnancy, conservative management, magnetic resonance imaging.