背景:腹内妊娠,虽然罕见,面临着独特的诊断和管理挑战。我们介绍了一个25岁的第2+1段,非洲黑人妇女,他从乌干达北部的外围健康中心四级转诊到地区转诊医院,原因是胎儿部位异常。这个案例强调了迅速诊断的意义,跨学科合作,手术计划,和管理晚期腹内妊娠的胎盘。
方法:一位25岁的非洲黑人女性,抵达区域转诊医院后的第2+1段,大学教学医院在一个周末,来自附近一家私人诊所的超声检查显示,在妊娠38周时发生了子宫外腹腔妊娠,她被迅速送回了大学教学医院。在这个诊断之后,病人,他来自30多公里外的一个偏远村庄,回到她的家人讨论。三天后,她又被录取了.紧急剖腹手术揭示了一个具有广泛胎盘附着的网膜妊娠囊。一名活的女婴成功分娩,胎盘留在原位。术后进展顺利,最初担心母乳流量不足,在第二次剖腹探查术中取出胎盘后解决。
结论:该案例突出了晚期腹内妊娠的罕见发生,并强调了多学科团队合作和胎盘管理的重要性。管理中的有利结果是基于对胎盘位置的全面评估,手术期间的附件和血液供应。它表明,如果有一个良好的附着延迟去除胎盘,可能会降低大量出血的风险。这对于牛奶稀释以及在资源有限的环境中减少输血需求尤为重要。
BACKGROUND: Intra-abdominal pregnancies, while rare, present with unique diagnostic and management challenges. We present a
case of a 25-year-old para 2 + 1, black African woman, who was referred from a peripheral Health Centre level IV in the Northern part of Uganda to a Regional Referral Hospital due to an abnormal presentation with easily palpable fetal parts. This
case emphasizes the significance of prompt diagnosis, interdisciplinary collaboration, surgical planning, and managing the placenta in advanced intra-abdominal pregnancies.
METHODS: A 25 year African black female, para 2 + 1 upon arrival at Regional Referral Hospital, a University Teaching Hospital during a weekend, an ultrasound was sourced from a nearby private clinic revealing an extra-uterine intra-abdominal pregnancy at 38 weeks of gestation and she was promptly sent back to the University Teaching Hospital. Following this diagnosis, the patient, who hailed from a remote village over 30 km away, returned to her family for discussions. After three days, she was readmitted. Emergency laparotomy unveiled an omental gestation sac with extensive placental attachment. A live female infant was delivered successfully, placenta was left in situ. The postoperative course was uneventful, with initial concerns about inadequate breast milk flow which resolved after placental removal during the second exploratory laparotomy.
CONCLUSIONS: This
case highlights the uncommon occurrence of an advanced intra-abdominal pregnancies and emphasizes the importance of multi-disciplinary teamwork and placental management. The favorable outcome in the management was based on thorough assessment of the placental location, attachments and blood supply during surgery. It demonstrates the possibility of reduced risk of massive bleeding if there is a delayed removal of placenta with favorable attachment. This is particularly important for milk letdown as well as reducing the needs of blood transfusion in resource limited settings.