PDF(Pubmed)
Abstract：
BACKGROUND: Abdominal pregnancy, a rare form of ectopic pregnancy, is associated with high morbidity and adverse consequences for future fertility. Early recognition and management reduce mortality and allow minimal invasive and conservative treatment. In modern medicine, primitive prevention to unexpected fatal pregnancies is crucial.
METHODS: A divorced 33-year-old \"self-identified\" infertile polycystic ovary woman diagnosed as repeated implantation failure in previous in vitro fertilization with her ex-husband ever presented in surgery department with a history of 15-day abdominal pain, nausea, and vomiting and 3-h worsening abdominal pain. The serum beta-human chorionic gonadotropin value was more than 10,000 m-international units per milliliter. Sonogram findings were significant for the absence of intrauterine gestation; a placenta and well-formed living fetus of second-trimester gestation were seen in the abdomen, accompanied by hemoperitoneum. A unique spontaneously second-trimester tubo-abdominal pregnancy was confirmed in emergent laparotomy by gynecologists, she received a removing of the living fetus, a right total salpingectomy, resection of partial omentum and blood transfusion. The patient recovered uneventfully and her serum beta-human chorionic gonadotropin returned to normal range on the 30th postoperative day, till now, she has weak fertility awareness because of her catastrophic experiences in the unexpected abdominal pregnancy.
CONCLUSIONS: This case highlights woman with a previous in vitro fertilization history may be in is a high risk to be delayed or missed in diagnosis in an intended ectopic pregnancy due to a fixed belief in infertility. Educational interventions and contraceptive care should be provided by fertility and healthcare practitioner. The possibility of abdominal pregnancy must always be suspected and dealt with promptly and appropriately by the astute clinician.
METHODS: A divorced 33-year-old \"self-identified\" infertile polycystic ovary woman diagnosed as repeated implantation failure in previous in vitro fertilization with her ex-husband ever presented in surgery department with a history of 15-day abdominal pain, nausea, and vomiting and 3-h worsening abdominal pain. The serum beta-human chorionic gonadotropin value was more than 10,000 m-international units per milliliter. Sonogram findings were significant for the absence of intrauterine gestation; a placenta and well-formed living fetus of second-trimester gestation were seen in the abdomen, accompanied by hemoperitoneum. A unique spontaneously second-trimester tubo-abdominal pregnancy was confirmed in emergent laparotomy by gynecologists, she received a removing of the living fetus, a right total salpingectomy, resection of partial omentum and blood transfusion. The patient recovered uneventfully and her serum beta-human chorionic gonadotropin returned to normal range on the 30th postoperative day, till now, she has weak fertility awareness because of her catastrophic experiences in the unexpected abdominal pregnancy.
CONCLUSIONS: This case highlights woman with a previous in vitro fertilization history may be in is a high risk to be delayed or missed in diagnosis in an intended ectopic pregnancy due to a fixed belief in infertility. Educational interventions and contraceptive care should be provided by fertility and healthcare practitioner. The possibility of abdominal pregnancy must always be suspected and dealt with promptly and appropriately by the astute clinician.
摘要：
背景：腹部妊娠，一种罕见的异位妊娠,与高发病率和对未来生育的不利后果有关。早期识别和管理可降低死亡率，并允许微创和保守治疗。在现代医学中,对意外致命怀孕的原始预防至关重要。
方法：一名离异的33岁“自我鉴定”的多囊卵巢不育妇女，在先前的体外受精中被诊断为反复种植失败，她的前夫曾在外科就诊，有15天腹痛史，恶心,呕吐和3小时恶化的腹痛。血清β-人绒毛膜促性腺激素值超过每毫升10,000m国际单位。超声检查结果对于没有宫内妊娠具有重要意义；在腹部可见胎盘和中期妊娠的形态良好的活胎，伴有腹膜积血.妇科医生在紧急剖腹手术中证实了独特的自然孕中期输卵管腹部妊娠，她接受了活体胎儿的切除,右全输卵管切除术,部分网膜切除和输血。患者恢复顺利，术后第30天血清β-人绒毛膜促性腺激素恢复正常，直到现在,由于在意外的腹部怀孕中经历了灾难性的经历，她的生育意识薄弱。
结论：该病例强调了有体外受精史的女性，由于对不孕症的坚定信念，在预期的异位妊娠中可能有延迟或漏诊的高风险。教育干预和避孕护理应由生育和保健医生提供。必须始终怀疑腹部妊娠的可能性，并由精明的临床医生及时适当地处理。
方法：一名离异的33岁“自我鉴定”的多囊卵巢不育妇女，在先前的体外受精中被诊断为反复种植失败，她的前夫曾在外科就诊，有15天腹痛史，恶心,呕吐和3小时恶化的腹痛。血清β-人绒毛膜促性腺激素值超过每毫升10,000m国际单位。超声检查结果对于没有宫内妊娠具有重要意义；在腹部可见胎盘和中期妊娠的形态良好的活胎，伴有腹膜积血.妇科医生在紧急剖腹手术中证实了独特的自然孕中期输卵管腹部妊娠，她接受了活体胎儿的切除,右全输卵管切除术,部分网膜切除和输血。患者恢复顺利，术后第30天血清β-人绒毛膜促性腺激素恢复正常，直到现在,由于在意外的腹部怀孕中经历了灾难性的经历，她的生育意识薄弱。
结论：该病例强调了有体外受精史的女性，由于对不孕症的坚定信念，在预期的异位妊娠中可能有延迟或漏诊的高风险。教育干预和避孕护理应由生育和保健医生提供。必须始终怀疑腹部妊娠的可能性，并由精明的临床医生及时适当地处理。
