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Advanced abdominal intraligamentary pregnancy with live birth
International Journal of Gynecology & Obstetrics 46 (1994) 327-328
Letter
to the editor
Advanced abdominal intraligamentary S. Mittal*,
P. Chhabra,
pregnancy with live birth R. Khanna
Department of Obsrerrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
Received 21 December 1993; revisionreceived 10 March 1994; accepted IO March 1994
Keyworrls:Abdominal pregnancy; Pregnancy - intraligamentary
Abdominal pregnancy is a rare but serious problem in obstetrics accounting for 1% of total ectopic pregnancies [I]. Intraligamentary pregnancy is still rarer with few reaching the stage of viability. An interesting case of advanced intraligamentary pregnancy with live birth is reported. A 28-year-old second gravida with first delivery 10 years earlier, presented in emergency at 30 weeks’ gestation with abdominal pain and vaginal bleeding for the previous 10 days. On examination she was poorly nourished, weighing 38 kg, with gross pallor (Hb 6.1 go/), pulse 108/min and BP 130/84 mmHg. On abdominal examination fundal height was 32 weeks, with increased basal tone and tenderness on the right side. A firm mass 10 x 12 cm, probably a fibroid, was felt on the left side. The fetus was lying transversely with a heart rate of 14O/min. Ultrasound revealed a live fetus in transverse position with biparietal diameter of 7.0 cm. The placenta was seen to occupy the lower segment with a retroplacental echo-free area. A diagnosis of placenta previa with partial separation was made. On emergency cesarean section, the uterus was * Corresponding author.
IO-week size, deviated to the left with pregnancy situated between the two layers of the broad ligament. A thick anterior layer was incised and the baby was delivered as breech. The baby weighed 1.43 kg with a I-min Apgar score of 9110 and no congenital anomaly. The placenta was perforating the posterior layer of the broad ligament with adhesions posteriorly to bowel and omentum. Adhesions were released by sharp dissection and a placenta weighing 250 g was removed. Both tubes and ovaries were normal. The patient was discharged after 10 days and both mother and child are well on follow-up after 2 years. Intraligamentary pregnancy is the rarest form of abdominal pregnancy situated between two layers of the broad ligament, bordered inferiorly by the levator muscles, laterally by the pelvic side wall, medially by the uterus and superiorly by the fallopian tube [2]. There are no clinical features specifically characteristic of this form of ectopic pregnancy to enable a preoperative diagnosis. A variety of preoperative diagnoses have been reported including a case where on repeated sonography the uterus was mistaken for a myoma [3]. There is high maternal and perinatal mortality [4] with increased risk of fetal deformities.
0020-7292/94/$07.00 0 1994 International Federation of Gynecology and Obstetrics SSDI 0020-7292(94)02091-C
Letters to the editor/M
328
J. Gynecol. Obstet. 46 (1994) 327-325
Presented here is a case where despite a very sick, malnourished mother and delivery of a premature fetus a successful outcome was achieved and both mother and infant are doing well at present.
[2]
[3]
References [l]
Breen J: A 21-year survey of 654 ectopic pregnancies. Am J Obstet Gynecol 106: 1004, 1970.
[4]
Paterson WG, Grant RA: Advanced intraligamentous pregnancy-report of a case, review of the literature and a discussion of the biological implications. Obstet Gynecol Surv 30: 715, 1975. Acien P, Milla A, Segarra F, Pinero JL: Advanced and unsuspected secondary abdominal pregnancy misdiagnosed before laparotomy. Int J Gynecol Obstet 25: 323, 1987. Rahman MS, Al-Suleiman SA, Rahman J, Al-Sibai NH et al.: Advanced abdominal pregnancy: observation in 10 cases. Obstet Gynecol 59: 366, 1982.
Letter
to the editor
Advanced abdominal intraligamentary S. Mittal*,
P. Chhabra,
pregnancy with live birth R. Khanna
Department of Obsrerrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
Received 21 December 1993; revisionreceived 10 March 1994; accepted IO March 1994
Keyworrls:Abdominal pregnancy; Pregnancy - intraligamentary
Abdominal pregnancy is a rare but serious problem in obstetrics accounting for 1% of total ectopic pregnancies [I]. Intraligamentary pregnancy is still rarer with few reaching the stage of viability. An interesting case of advanced intraligamentary pregnancy with live birth is reported. A 28-year-old second gravida with first delivery 10 years earlier, presented in emergency at 30 weeks’ gestation with abdominal pain and vaginal bleeding for the previous 10 days. On examination she was poorly nourished, weighing 38 kg, with gross pallor (Hb 6.1 go/), pulse 108/min and BP 130/84 mmHg. On abdominal examination fundal height was 32 weeks, with increased basal tone and tenderness on the right side. A firm mass 10 x 12 cm, probably a fibroid, was felt on the left side. The fetus was lying transversely with a heart rate of 14O/min. Ultrasound revealed a live fetus in transverse position with biparietal diameter of 7.0 cm. The placenta was seen to occupy the lower segment with a retroplacental echo-free area. A diagnosis of placenta previa with partial separation was made. On emergency cesarean section, the uterus was * Corresponding author.
IO-week size, deviated to the left with pregnancy situated between the two layers of the broad ligament. A thick anterior layer was incised and the baby was delivered as breech. The baby weighed 1.43 kg with a I-min Apgar score of 9110 and no congenital anomaly. The placenta was perforating the posterior layer of the broad ligament with adhesions posteriorly to bowel and omentum. Adhesions were released by sharp dissection and a placenta weighing 250 g was removed. Both tubes and ovaries were normal. The patient was discharged after 10 days and both mother and child are well on follow-up after 2 years. Intraligamentary pregnancy is the rarest form of abdominal pregnancy situated between two layers of the broad ligament, bordered inferiorly by the levator muscles, laterally by the pelvic side wall, medially by the uterus and superiorly by the fallopian tube [2]. There are no clinical features specifically characteristic of this form of ectopic pregnancy to enable a preoperative diagnosis. A variety of preoperative diagnoses have been reported including a case where on repeated sonography the uterus was mistaken for a myoma [3]. There is high maternal and perinatal mortality [4] with increased risk of fetal deformities.
0020-7292/94/$07.00 0 1994 International Federation of Gynecology and Obstetrics SSDI 0020-7292(94)02091-C
Letters to the editor/M
328
J. Gynecol. Obstet. 46 (1994) 327-325
Presented here is a case where despite a very sick, malnourished mother and delivery of a premature fetus a successful outcome was achieved and both mother and infant are doing well at present.
[2]
[3]
References [l]
Breen J: A 21-year survey of 654 ectopic pregnancies. Am J Obstet Gynecol 106: 1004, 1970.
[4]
Paterson WG, Grant RA: Advanced intraligamentous pregnancy-report of a case, review of the literature and a discussion of the biological implications. Obstet Gynecol Surv 30: 715, 1975. Acien P, Milla A, Segarra F, Pinero JL: Advanced and unsuspected secondary abdominal pregnancy misdiagnosed before laparotomy. Int J Gynecol Obstet 25: 323, 1987. Rahman MS, Al-Suleiman SA, Rahman J, Al-Sibai NH et al.: Advanced abdominal pregnancy: observation in 10 cases. Obstet Gynecol 59: 366, 1982.