RESUMEN
Abdominal pregnancy is a rare form of ectopic pregnancy where implantation and development of the egg take place in the peritoneal cavity outside the tubo-uterine mucosa, in contact with intestinal loops. Diagnosis is most often difficult. We report the case of a 32-year-old woman (gravida 1, para 1), with a history of PCOS, diagnosed with abdominal pregnancy at 20 weeks of amenorrhea complicated by acute intestinal obstruction. Diagnosis was confirmed by abdomino-pelvic scan. Surgery was performed with the patient under general anesthesia. She presented a macerated fetus with an infiltration of the placenta causing a perforation of the sigmoid colon and uterus. Hartmann's procedure was performed and the perforation of the uterus was sutured. Abdominal pregnancy remains a rare variety of ectopic pregnancy. Preoperative diagnosis is difficult due to the presence of a variety of non-specific symptoms. This type of ectopic pregnancy remains challenging for gynecologists and radiologists.
Asunto(s)
Obstrucción Intestinal , Síndrome del Ovario Poliquístico , Embarazo Abdominal , Humanos , Femenino , Embarazo , Adulto , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico , Embarazo Abdominal/cirugía , Embarazo Abdominal/diagnóstico , Síndrome del Ovario Poliquístico/complicaciones , Síndrome del Ovario Poliquístico/diagnósticoRESUMEN
Bilateral ectopic pregnancy is very rare. Although the frequency of ectopic bilateral pregnancy has increased with the advent of medically assisted procreation, spontaneous bilateral tubal pregnancies remain rare. Early detection of this type of ectopic pregnancy is important to prevent maternal mortality and morbidity. Conservative surgery must also be considered, as preservation of both tubes is presumed to offer better fertility prospects. We report the case of a 35-year-old patient at five weeks of amenorrhea with bilateral ectopic pregnancy diagnosed based on ultrasound scans and confirmed during laparotomy. A 35-year-old woman with a history of three vaginal deliveries, non-smoker, on contraceptives (microprogestins), presented with pelvic pain and amenorrhea of five weeks. A beta HCG test came back positive. Pelvic ultrasound revealed a moderate hemoperitoneum and an empty uterus with hematometra. It also showed heterogeneous left and right adnexal masses measuring 3 cm and 4 cm, respectively. An emergency laparotomy was performed. Per-operatively, two bilateral tubal pregnancies of 3 cm and 4 cm were founded. The patient received conservative treatment with bilateral salpingotomy. Postoperative management was uneventful. The diagnosis of spontaneous bilateral tubal ectopic pregnancy is rare and often established at the time of surgery, hence the importance of a rigorous and vigilant examination of the two tubes during ultrasound examination and surgery, so as not to miss it and to better prevent maternal mortality. Conservative surgery must be carefully chosen.
Asunto(s)
Embarazo Tubario , Humanos , Femenino , Embarazo , Adulto , Embarazo Tubario/diagnóstico , Embarazo Tubario/cirugía , UltrasonografíaRESUMEN
Acute organophosphorus pesticides (OPs) poisoning during pregnancy are rare events, not well documented in the literature. We conducted a retrospective analysis of outcomes in seven cases of suicidal ingestion of OP in pregnant women. This intoxication was most often serious. Indeed, five of seven parturients had an initial Glasgow score < 9 and the POP score was ≥ 3 in all parturients. Five patients required mechanical ventilation for a mean duration of 3,4 days. All patients reported favorable outcomes but in more than half of the cases fetuses had unfavorable outcomes (fetal death in utero). Two mechanisms can explain these fetal complications. The first mechanism is fetal hypoxia, associated or not with a state of shock, which can be reflected in the Fetal Heart Rate (FHR) by tachycardia or decelerations and result in intrauterine fetal death. The second mechanism is the passage of these pesticides through the placental barrier representing a potential risk to the fetus due to the alteration of the microsomal enzyme systems.