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Baby outside uterus: Signs, Causes, Diagnosis, and Treatment

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Ectopic pregnancy

What is an ectopic pregnancy?

An ectopic pregnancy occurs when a fertilised egg implants outside the uterus (womb).

In a normal pregnancy, the fertilised egg spends 4 to 5 days travelling down the fallopian tube before moving to the cavity of the uterus where it implants about 6 to 7 days after being fertilised.

Most, but not all, ectopic pregnancies take place in the fallopian tube. Early detection of an ectopic pregnancy can prevent serious medical complications and may save the fallopian tube from permanent damage.

Cause of ectopic pregnancies

There are several conditions that can cause an ectopic pregnancy.

Any damage to the fallopian tube can block or narrow the fallopian tube. There could also be problems with the tube walls, which should normally tighten and carry the fertilised egg into the uterus.

Hormonal imbalance, infection or malfunction of the uterus or tube can all impair the tube’s normal function and result in an ectopic pregnancy.

Who is most at risk?

You are most at risk of having an ectopic pregnancy if you have a previous history of:

  • ectopic pregnancy
  • salpingitis (pelvic infection)
  • damage to your fallopian tube
  • infertility
  • pelvic surgery including tubal ligation (having your fallopian tubes’ tied or clamped to prevent pregnancy). 

Other risk factors include:

In some cases the cause of an ectopic pregnancy may never be known.

Possible outcomes

In many cases of ectopic pregnancy, the fertilised egg dies quickly and is broken down by your system before you miss your period or after you experience some slight pain and bleeding.

In these cases an ectopic pregnancy is rarely diagnosed and it is assumed to be a miscarriage. Nothing needs to be done in these circumstances.

If the fertilised egg continues to grow, the thin wall of your fallopian tube will stretch, causing you pain in your lower abdomen. You may also experience vaginal bleeding. As the egg grows, the tube may rupture, causing you severe abdominal (stomach) pain, internal bleeding and possible collapse.

Signs and symptoms

Women who experience an ectopic pregnancy have all the signs of a normal pregnancy, in the beginning. Most symptoms of an ectopic pregnancy occur between the fourth and tenth week of pregnancy. These include:

  • vaginal bleeding
  • lower left or right side abdominal (stomach) pain
  • feeling light-headed or faint.

If you experience these symptoms you should see your doctor or visit your local hospital immediately.

Managing an ectopic pregnancy

If an ectopic pregnancy is suspected, your doctor will perform an ultrasound scan and a pregnancy test.

If the ultrasound scan shows an empty uterus but the pregnancy test comes back positive, then it is likely you have an ectopic pregnancy.

These signs may also indicate that you are in very early stages of pregnancy or that you have already miscarried.

While an ultrasound using a transvaginal probe provides the best quality scan, it is not always possible to see an ectopic pregnancy.

If you are well and not in severe pain, you may have a blood hormone test each day for up to 2 to 3 days to help diagnose if you have an ectopic pregnancy.

Treatment of ectopic pregnancy

Currently there are 3 different treatments available for an ectopic pregnancy.

Your doctor will discuss the most appropriate one for you, however, your doctor may also find it necessary to proceed from one method to another.

Laparoscopic (keyhole) surgery to remove fertilised egg from fallopian tubes

A telescopic device (the laparoscope) is inserted through a small cut below your navel (belly button). To help identify your organs, carbon dioxide gas is blown into your stomach through a needle.

A couple of small incisions are also made in your lower abdomen to manipulate and if necessary remove the ectopic pregnancy tissue.

The surgery may involve removing your fallopian tube (salpingectomy) or opening your fallopian tube (salpingostomy) to remove the ectopic pregnancy tissue.

Laparotomy to remove the ectopic pregnancy

If the pregnancy is advanced or there has been significant associated haemorrhaging (bleeding) then your doctor may perform a laparotomy, a type of surgery involving a much larger incision.

Intramuscular injection of the drug methotrexate

A medication called methotrexate is used to dissolve the pregnancy tissue. It is given by injection in the leg or bottom and is suitable for women without pain or those with minimal pain.

This type of treatment was introduced to avoid surgery but needs careful follow-up.

The follow-up requires blood tests after the first week and then once or twice a week until tests show that you are no longer pregnant. The schedule of blood tests will be explained to you by your doctor. The treatment has a 90 per cent success rate. If it is not successful your doctor may have to reconsider medical treatment or surgery.

Recovery after treatment

After laparoscopic surgery or a methotrexate injection most women recover and are ready to leave hospital within 24 hours.

After a laparotomy it is more common to stay in hospital for 2 to 3 days.

If you had a salpingostomy or methotrexate injection you will need to have regular tests at hospital to ensure all the pregnancy cells are gone. This usually involves another blood hormone test.

A discharge summary will be sent to your doctor describing the treatment you have received and any further care you may need.

See your doctor if:

  • you have a high temperature or feel feverish
  • your surgical cuts become red, swollen or contain pus
  • your vaginal discharge has a strong, unpleasant odour
  • you have heavy, bright red vaginal blood loss or blood clots
  • you feel unwell or worried about an unusual symptom.

Future pregnancies

If you have had an ectopic pregnancy then you have a slightly higher risk of having another ectopic pregnancy in the future.

The risk of ectopic pregnancy in the general population is 1 in 50 to 80 women. The risk of a repeat ectopic pregnancy is 1 in 10.

See your doctor immediately if you:

  • think you might be pregnant
  • have a late period
  • have abnormal abdominal pain
  • have menstrual bleeding that is different to normal.

You should ask to be examined, reminding your doctor of the previous ectopic pregnancy.

Contraception

If you have had an ectopic pregnancy, some contraception methods may no longer be suitable. It is best to discuss your medical history and options with your doctor or at a family planning clinic.

Your emotions

An ectopic pregnancy can be a devastating experience.

You may be recovering from major surgery while at the same time trying to cope with the loss of your pregnancy and possibly the loss of part of your fertility. You may be worried about whether you can have a baby in the future.

You may also be dealing with the shock of finding out you were pregnant just as your pregnancy is ending.

It’s normal for your emotions to be up and down for weeks and even months after your loss. You may feel utterly relieved to be pain free and profoundly grateful to be alive, while feeling sad about your loss.

If you didn’t have much time to mentally prepare for your treatment, you may feel that you lost control of the decision-making process.

These emotional reactions that you and your partner may experience can test your own relationship and your relationships with others, such as family and friend. You both may find it hard to understand or meet each other’s emotional needs.

Many people, especially men, may find it difficult to express their feelings. They may feel powerless to help. During this time it’s important to talk to each other about how you both feel and share your grief.

After experiencing an ectopic pregnancy your feelings can vary. Some women want to get pregnant again immediately while others are terrified at the thought and cannot cope with another anxious pregnancy.

Allow yourself time to recover physically and emotionally before trying to get pregnant again. It is recommended that you wait for at least 3 months for your body to recover. You are the best judge of the time needed for your emotional healing.

Getting support

Support services at King Edward Memorial Hospital

A range of support services are available at King Edward Memorial Hospital if you have experience a pregnancy loss, including:

  • social work
  • pastoral care
  • counselling and psychiatric services.

Talk to your doctor or midwife, or read more about the support services for pregnancy loss available at King Edward Memorial Hospital.

You may wish to read such resources as:

  • Small sparks of life Lysanne Sizoo, Gopher Publishers, 2001
  • Hidden Loss: Miscarriage & Ectopic Pregnancy. Contributing editors: Valerie Hey, Catherine Itzen, Lesley Saunders, and Mary Anne Speakman. The Women’s Press Handbook Series 1989.

Where to get help

Remember

  • Ectopic pregnancy is a pregnancy that develops outside of the uterus and usually in the fallopian tubes.
  • Symptoms can include vaginal bleeding, stomach pain and cramps.
  • Women at high risk should have their pregnancy closely monitored especially during the early stages.
  • An ectopic pregnancy is a life-threatening condition.

Acknowledgements
Women and Newborn Health Service


This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.

Ectopic Pregnancy 101 | by Every Mother Counts

Everything you need to know about an ectopic pregnancy, an increasingly more common pregnancy complication.

One of every 50 pregnancies results in an ectopic pregnancy, which is where embryonic development occurs somewhere other than inside the uterus. What many people don’t realize is how potentially life threatening they can be. Recently, two friends of Every Mother Counts experienced ectopic pregnancies and we thought it was time to discuss this increasingly more common pregnancy complication.

What is an ectopic pregnancy?

When a fertilized egg can’t travel smoothly through the fallopian tube to the uterus where a normal pregnancy develops, it may try to implant somewhere else. In 98 percent of ectopic cases, the fertilized egg implants and grows inside the fallopian tube. The other 2 percent develop in other areas of the abdominal cavity or in the cervix.

How often do they happen?

They occur in about 2 percent of pregnancies, which is a significant increase from the 1970s when only 0.45 percent of pregnancies were ectopic. It’s thought that the increase has to do with improved diagnostic technologies, plus increased rates of sexually transmitted diseases and other conditions that cause pelvic inflammatory disease and scarring of the reproductive organs.

What are the symptoms?

The symptoms most commonly associated with ectopic pregnancy are abdominal pain, spotting, bleeding, nausea, weakness, dizziness and low blood pressure. If the tube has already ruptured, a mother may show symptoms of shock (pale skin, weakness, loss of consciousness, confusion, rapid pulse).

How is it diagnosed?

When a pregnant woman comes to her physician with abdominal pain, with or without bleeding, or if she has similar symptoms and is unaware that she’s pregnant, the first step is to confirm the pregnancy. This involves a blood test to evaluate her pregnancy hormone levels and an ultrasound to visualize the location of the developing fetus plus a pelvic exam. Once an ectopic pregnancy is diagnosed, treatment depends on how far along the pregnancy is and the severity or stability of mom’s condition.

What happens to the fetus?

The fetus rarely survives longer than a few weeks because tissues outside the uterus do not provide the necessary blood supply and structural support to promote placental growth and circulation to the developing fetus. If it’s not diagnosed in time, generally between 6 and 16 weeks, the fallopian tube will rupture. This is long before a fetus could survive outside of the mother’s body. The sad truth is that when a pregnancy is ectopic, the fetus will not survive.

How is it treated?

There is no medical technique for transferring an ectopic pregnancy to the uterus where it could develop into a healthy pregnancy and baby. The only treatment that ensures mom’s survival is termination of the pregnancy. This is called a therapeutic abortion because it is required to save mom’s health or life.

Occasionally, a mother’s ectopic pregnancy will resolve without treatment if the pregnancy spontaneously absorbs. The problem is we don’t have specific data that predicts which women will recover without treatment and which ones will suffer severe consequences. That’s why most cases of ectopic pregnancy are treated by aborting the pregnancy. That’s done in one of two ways:

  • By injecting the mother with a drug called methotraxate, or
  • By surgically by removing the tube and fetus

Methotrexate is commonly used for treating cancer because it destroys rapidly dividing cells. In pregnancy, the rapidly dividing cells are embryonic and placental, which shrink and are absorbed by the mother’s body. It’s estimated that 35 percent of patients can be treated successfully with methotrexate when the fetus is in an early stage of development, the tube has not ruptured and there’s no extensive abdominal damage.

Surgical removal of the tube and fetus may be done either through a small incision in the naval or a larger incision in the low abdomen that’s similar to one used for a C-section.

What happens to the mother?

Sometimes, ectopic pregnancies result in miscarriages, but more often, the fallopian tube where the fetus is implanted stretches and becomes inflamed and extremely painful. Most cases of ectopic pregnancy require emergency medical treatment because the growing fetus can cause the fallopian tube to rupture and as a result, massive internal bleeding can occur.

In developed, high-income countries where emergency health care is easily accessible, severe injury or death is rare. That’s because an ectopic pregnancy’s hallmark symptom — severe abdominal pain — drives women to get medical help immediately.

Prior to the age of modern medicine and even today in countries where safe diagnostic and surgical techniques are unavailable, ectopic pregnancy can result in maternal death in more than 50 percent of cases. In fact, it’s the leading cause of maternal mortality in the first trimester. When women can access the right healthcare, risk for death drops to less than five in 10,000 pregnancies.

Accurate statistics for maternal outcomes in developing countries are difficult to come by. Jessica Bowers, Every Mother Counts’ Portfolio Director has a masters in International Development from George Washington University and has travelled extensively in developing countries, working in areas where maternal health outcomes are dire. Bowers says, “Ectopic pregnancies usually occur so early in pregnancy and health centers may not have the technology or see the patient early enough to detect it, or may not have a record keeping system that records it.”

Can mom get pregnant again?

Many women can get pregnant again and go on to deliver healthy babies, but it depends on what caused her ectopic pregnancy in the first place, how much abdominal damage occurred, whether she still has a remaining fallopian tube and her willingness to risk having another complication. When a woman has had one ectopic pregnancy, she has a 15 percent chance of having another. If she’s had two ectopics, the recurrence rate is 30 percent.

What happened to our friends?

Jennifer Pastiloff, writer, yoga retreat leader and founder of the Manifest Station, experienced pain and bleeding shortly after discovering she was pregnant last year. She had known from the start that something was wrong and when her doctor diagnosed her pregnancy as ectopic, she was successfully, but painfully treated with methotrexate. Jennifer wrote an eloquent essay for The Rumpus about hopping on a plane to lead a yoga retreat shortly after receiving the injection. When the pain became too intense for her to continue teaching, she went to the emergency room for pain medication and reassurance that everything would be all right. The methotrexate worked, though not without a great deal of discomfort.

Christine Koenitzer is one of EMC’s running ambassadors and she’s experienced two ectopic pregnancies this year. Though her ectopic was treated surgically just two weeks ago (after methotrexate didn’t work), she’s recovered well enough that she’ll be participating in the JoyRide and Kilometers Ridgfield 5K race this weekend in Connecticut as a fundraiser for Every Mother Counts.

Term Abdominal Pregnancy with Healthy Newborn: A Case Report

Ghana Med J. 2011 Jun; 45(2): 81–83.

Upper East Regional Hospital, P.O. Box 26, Bolgatanga, Ghana

Conflict of Interest: None Declared

This article has been cited by other articles in PMC.

Summary

Abdominal pregnancy is a rare form of ectopic pregnancy with very high morbidity and mortality for both the mother and the foetus. Diagnosis and management can pose some difficulties especially in low-resource centres. High index of suspicion is vital in making prompt diagnosis in such situations. A case of abdominal pregnancy that resulted in a live healthy newborn at a Regional Hospital in Ghana is presented.

Keywords: abdominal pregnancy, live baby, ectopic, placenta

Introduction

Ectopic pregnancy represents about 1–2% of all pregnancies with 95% occurring in the fallopian tube. Abdominal pregnancies represent just about 1% of ectopic pregnancies.1 The incidence of abdominal pregnancy differs in various publications and ranges between 1: 10000 pregnancies and 1:30,000 pregnancies.1,2 It was reported for the first time in 1708 as an autopsy finding and numerous cases have been reported worldwide ever since. In most of these cases, the diagnosis is made on the basis of the ensuing complications such as hemorrhage and abdominal pain. Maternal mortality and morbidity are also very high especially if the condition is not diagnosed and managed appropriately. These pregnancies generally do not get to 37 weeks (term gestation) and usually the end result is the extraction of a dead fetus. Another challenge for babies from abdominal pregnancy is the very high incidence of congenital malformations.

Abdominal pregnancy at term with a healthy viable fetus is therefore an extremely rare condition and very few of such cases have been published during the last ten years. We present a case of abdominal pregnancy that resulted in a term live baby without malformations.

Case Report

A 31- year- old woman, Gravida 3 Para 1, was referred from a District Hospital on 17th June 2008 at 8:00am. Her principal complaint on arrival was severe abdominal pain. She had irregular menstrual cycles prior to her pregnancy and was not sure of her last date of menstruation. The patient suffered from severe abdominal pain and vaginal bleeding which kept her out of work during the first trimester but the second trimester was incident free. She was, however, again kept out of work during the third trimester with abdominal pain. Her antenatal card indicated nine visits and a gestational age of 38 weeks at the time of referral.

On examination, she looked generally stable. She was not pale; vital signs were within normal parameters. Cardiovascular and respiratory systems did not reveal any abnormalities. The abdominal examination revealed symphysio-fundal height of 33cm, transverse lie, foetal heart rate of 136 beats per minute and no uterine contractions.

Vaginal examination revealed posterior located cervix measuring 2cm long without dilatation. There was no vaginal bleeding. She had five ultrasound scan examination with the last two within seven days of presentation indicating intrauterine gestation with transverse lie. The rest of her investigations were normal. The haemoglobin level was 10.9g/dl and blood group was O Rhesus positive. She was booked for emergency caesarean section on account of transverse lie at term.

At laparotomy the following findings were made: Abdominal pregnancy with a live female baby weighing 2.3 kilograms and meconium stained liquor. The placenta was extensively adherent to segments of large bowel, omentum and left cornual region of the uterus ().

Normal sized uterus and placenta implanted on segment of bowel

The uterus, right tube and both ovaries were normal but the left tube was not identified. Other abdominal organs were normal.

There was significant bleeding from some detached portions of the placenta, which prompted removal of the detached placenta tissue to facilitate haemostasis. The rest of the placenta was left in situ. Haemostasis was secured. Total estimated trans-operative bleeding was one litre.

A unit of compatible blood was transfused intraoperatively. The patient progressed well and was discharged on the fifth postoperative day. She was followed up weekly for four weeks. Abdominal ultrasound after six weeks showed normal size uterus and ovaries and the portion of placenta that was left in situ was not identified. Beta human chorionic gonadotropin (BhCG) was negative at the same period. All investigations by the neonatologist and the general paediatrician did not show any abnormality on the baby. The patient was finally discharged home.

Discussions

Advanced abdominal pregnancy is extremely rare. In a review at the Komfo Anokye Teaching Hospital, Opare-Addo et al reported an incidence of 1:1320 deliveries3 whilst Amirtha et al cited 1:25000 deliveries.4 Most of the cases of abdominal pregnancies are secondary from aborted or ruptured tubal pregnancy. 4 In this case it was obvious that the abdominal implantation was secondary to undiagnosed ruptured left tubal ectopic pregnancy. Clinical diagnosis can be very difficult and ultrasound is very helpful during the early stages of gestation but can also be disappointing in the later stages.

Other radiological studies such as MRI and CT scan are helpful in the later stages.5 Teng et al reported an interesting case in which MRI played a decisive role in the diagnosis6, unfortunately these advanced imaging technologies are not available in most parts of the third world. Our patient had five ultrasound scan examinations and none of these suggested the possibility of abdominal pregnancy. In poorly resourced centres, high index of suspicion is key for prompt diagnosis and timely intervention to prevent life-threatening complications.

In our opinion, bleeding from placental implantation site is the most life-threatening complication during laparotomy. The decision to remove the placenta or not can be a determining factor for the survival or otherwise of the woman and this decision is subject to the surgeon’s expertise and the particular case in question. It is generally recommended to leave the placenta in situ and make a follow up with human chorionic gonadotropin levels.7 In this case there was significant bleeding from some detached portions of the placenta that prompted removal of these portions to secure haemostasis. The patient was transfused with one unit of blood during the operation and that was enough. For the newborn, it is very important to rule out congenital malformations. There are reports of foetal malformations as high as 40% associated with abdominal pregnancies and only 50% of these babies survive up to one week post delivery.8,9

In his extensive review, Stevens found some varying degrees of deformations and malformations in 21.4% of these infants. In this case that has been presented; no malformation has been found on the child after ten months.

Conclusions

Abdominal pregnancy with resultant healthy newborn is very rare. Diagnosis of the condition can be difficult especially if the pregnancy is advanced. High level of suspicion, careful clinical and ultrasound examinations are the routine means of diagnosis though C T scan and MRI can be useful. Bleeding is the single most important life-threatening complication for the mother whilst fetal malformation is one of the numerous challenges that can confront the newborn.

Acknowledgement

We wish to acknowledge the kind comments and guidance of Dr R.M.K Adanu on this case report.

References

1. Nwobodo EI. Abdominal pregnancy. A case report. Ann Afr Med. 2004;3(4):195–196. [Google Scholar]2. Badria L, Amarin Z, Jaradat A, Zahawi H, Gharaibeh A. Full-term viable abdominal pregnancy. A case report and review. Arch Gynaecol Obstet. 2003;268(4):340–342. [PubMed] [Google Scholar]3. Opare-Addo HS, Daganus S. Advanced abdominal pregnancy: a study of 13 consecutive cases seen in 1993 and 1994 at Komfo Anokye Teaching Hospital, Kumasi, Ghana. Afr J Reproductive Health. 2000;4(1):28–39. [PubMed] [Google Scholar]4. Amritha B, Sumangali T, Priya B, Deepak S, Rai S. A rare case of term viable secondary abdominal pregnancy following rupture of a rudimentary horn. A case report. J Med case reports. 2009;3:38. [PMC free article] [PubMed] [Google Scholar]5. Karat LS. Viable Abdominal Pregnancy. J Obstet Gynecol India. 2007;57(2):169–170. [Google Scholar]6. Cunningham F, Gant N, Leveno K, et al. Williams Obstetrics. 21. Mcgraw-Hill; 2001. Ectopic Pregnancy; pp. 899–902. [Google Scholar]7. Jianping Z, Fen L, Qiu S. Full-Term Abdominal Pregnancy. A Case Report and Review of the Literature. Gynecol Obstet Invest. 2008;65(2):139–141. [PubMed] [Google Scholar]8. Teng H, Kumar G, Ramli N. A viable secondary intra-abdominal pregnancy resulting from rupture of uterine scar: role of MRI. Br J Radiol. 2007;80:134–136. [PubMed] [Google Scholar]9. Kun K, Wong P, Ho M, Tai C. Abdominal pregnancy presenting as a missed abortion at 16 weeks gestation. Hong Kong Med J. 2000;6(4):425–427. [PubMed] [Google Scholar]10. Stevens CA. Malformations and deformations in abdominal pregnancy. Am J Med Genet. 1993;47(8):1189–1195. [PubMed] [Google Scholar]

Advanced Extrauterine Pregnancy at 33 Weeks with a Healthy Newborn

Abdominal pregnancy is a very rare form of ectopic pregnancy, associated with high morbidity and mortality for both fetus and mother. It is, and often, seen in poor resource nations, where early diagnosis is often a major challenge due to poor prenatal care and lack of medical resources. An advanced abdominal pregnancy with a good fetal and maternal outcome is therefore a more extraordinary occurrence in the modern developed world. We present a case of an abdominal pregnancy at 33.4 weeks in an individual with no documented prenatal care, who arrived in a hospital in the Bronx, in June 25th 2014, with symptoms of generalized, severe lower abdominal pain. Upon examination it was found that due to category III fetal tracing an emergent cesarean section was performed. At the time of laparotomy the fetus was located in the pelvis covered by the uterine serosa, with distortion of the entire right adnexa and invasion to the right parametrium. The placenta invaded the pouch of Douglas and the lower part of the sigmoid colon. A massive hemorrhage followed, followed by a supracervical hysterectomy. A viable infant was delivered and mother discharged on postoperative day 4.

1. Introduction

Symptoms of an abdominal pregnancy are very nonspecific and often include abdominal pain, nausea, vomiting, palpable fetal parts, fetal mal presentation, pain on fetal movement, and displacement of the cervix.

With remarkable advances in radiographic technology an early discovery of an extrauterine pregnancy should be a practicable endeavor. This is particularly important in a community where there are an increased number of immigrants from low resource nations [1].

The prevalence of ectopic pregnancy is 1-2% with 95% occurring in the fallopian tube. The incidence of abdominal pregnancy ranges from 1 : 1000 to 1 : 30,000 depending on the community but is most commonly seen in developing nations of the world [2, 3], which represent approximately 1–1.4% of all ectopic pregnancies alone [4–6]. The first documented case of abdominal pregnancy was reported in the year 1708, followed by numerous case reports particularly from middle and low income regions of the world [7]. Frequently, the diagnosis was made based on complications such as hemorrhage and abdominal pain at the time of laparotomy. Most often, the pregnancy did not survive and often resulted in extraction of the dead fetus with increased maternal mortality.

In the developed world, abdominal pregnancy is extremely rare and very few of such cases have been published in the last 10 years. It is unclear if abdominal pregnancy is a result of secondary implantation from an aborted tubal pregnancy or result of primary implantation from intra-abdominal fertilization. Associated risks for developing abdominal pregnancy are endometriosis, pelvic inflammatory disease, assisted reproductive techniques, tubal occlusion, and multiparity [8–10].

In view of rarity and lack of management guidelines of advanced abdominal pregnancy, we expose this case of abdominal pregnancy in order to present the symptoms associated that could lead to an early recognition and the successful management that resulted in a good maternal and fetal outcome.

2. Case Report

A 27-year-old G2P0010 at 33 weeks and 4 days by last menstrual period was brought in by Emergency System to the hospital on June 25th 2014, with complaints of severe abdominal pain of 1 hour duration. Patient was without medical or surgical history and had a termination of pregnancy before. Abdominal pain was generalized, 10 out of 10 in severity, and associated with vomiting. She denied any diarrhea, vaginal bleeding, or leakage of amniotic fluid. She had recently migrated from the Dominican Republic in May 2014 with no record of prenatal care.

On examination, patient was in visible pain with elevated blood pressure, maternal tachycardia, and bilious emesis. An abdominal examination revealed generalized tenderness with guarding and rebound and a fundal height of 34 cm. The fetal heart rate was category III with absent variability and repetitive late decelerations. A vaginal examination revealed a bulging pouch of Douglas with the presenting part deep in the pelvis: a short, firm, and closed cervix displaced anteriorly behind the pubic symphysis.

On the way to the operating room limited bed side sonogram revealed fetus in cephalic and a questionable placental location. A tentative diagnosis of uterine rupture versus concealed placental abruption was made proceeding with immediate abdominal delivery.

At the time of laparotomy, meconium stained amniotic fluid was seen upon entry to the peritoneal cavity. A fetus was located outside of the endometrial cavity covered only by the uterine serosa on the right side with a placenta attachment to the serosa of the uterus. The left ovary was unremarkable in appearance and an anatomical distortion of the right adnexa was appreciated. A large opening was noted on the posterior aspect of the serosa where the amniotic fluid was leaking.

An incision was made on the protruding serosa and a viable female infant was delivered via cephalic presentation with Apgar score of 9/9 at 1 and 5 minutes with weight of 2362 g. The uterus and placenta were exteriorized after delivery due to massive bleeding and distortion of the anatomy (Figure 1). On further inspection of the placenta, it was noted to invade the pouch of Douglas and lower part of the sigmoid colon and the right uterine serosa.

A massive hemorrhage protocol was initiated and an emergency back-up team was called. A general surgical consult was requested due to involvement of bowel. The decision was made to proceed on hysterectomy and removal of the placenta tissue due to continuous bleeding. The patient underwent supracervical hysterectomy and excision of the placenta tissue occupying the right side of the pelvic floor. Adhesiolysis from the sigmoid colon was performed by surgery with minimal damage to the serosa.

Intraoperatively, the patient received 6 units of packed red blood cells, 4 units of fresh frozen plasma, and one unit of platelets. Estimated blood loss was 3000 mL. The patient was then transferred to the ICU for further observation and extubated the following morning.

She was discharged home with the baby on day 4 after surgery. There was no evidence of anomaly documented in the baby. Mother and baby are doing well and currently being followed up closely.

A pathology report revealed that placenta with a segment of trivessel umbilical cord marked old infarct at fetal and maternal surfaces. Attached to the maternal surfaces are fibrous tissues with smooth muscle and dilated vessels. Focal endovasculopathy with luminal occlusion, focal amnion with squamous metaplasia with an attached stretched ovary and fragment of mostly chorionic villi.

The uterus was described as intact and weighed 300 g measuring 9.5 cm in length, 11 cm from cornua to cornua and 6 cm anterior posterior diameter with thick endometrial, decidual changes and focal autolysis, no chorionic villi or trophoblast are seen in the endometrium.

3. Discussion

Primary abdominal pregnancy refers to an extrauterine pregnancy where implantation of fertilized ovum occurs directly in the abdominal cavity while the secondary abdominal pregnancy is a tubal pregnancy that ruptures with reimplantation within the abdominal cavity usually resulting in tubal or ovarian damage [10].

In this report, the findings of recurrent pain throughout pregnancy especially during fetal movement, signs of peritonitis on day of presentation with free fluid in the abdomen, and findings of intraoperative distortion of the right ovary and fallopian tube are more indicative of a ruptured tubal pregnancy with a secondary implantation on the serosa and the right broad ligament. Nunyaluendo and Einterz [11], in a recent review of 163 cases of abdominal pregnancy, revealed that identification of this condition is often missed with only 45% cases diagnosed during the prenatal period. In this case, patient did not have any prenatal care and had history of intermittent pain throughout the pregnancy. Another factor to consider is the fact that she had a previous termination of pregnancy in the first trimester via suction curettage previously to this pregnancy in 2012 that could cause a defect in the uterus.

Interestingly, the most common symptoms in abdominal pregnancy are abdominal pain 100%, nausea and vomiting 70%, and general malaise 40% [12]. Our patient had sudden severe abdominal pain with vomiting one hour prior to presentation to the hospital. A high index of suspicion for possible rupture of uterus versus abdominal pregnancy should be always considered when the fetal parts are easily palpated on abdominal examination and signs and symptoms of an acute abdomen. However a vaginal examination revealed fetal head bulging through the pouch of Douglas displacing the cervix into the retropubic space as described before is a concerning finding.

An abdominal pregnancy is often associated with fetal deformities [13], such as facial and cranial asymmetry, joint abnormalities and limb deformity, and central nervous deformities in about 21% of cases. In our case, there was no evidence of deformity or abnormalities as per the team of pediatricians.

Bleeding from placental implantation site could be massive and life threatening and is often the most common cause of maternal mortality which can reach as high as 20–30%. The decision to remove or leave the placenta should depend on extent of the placentation particularly with the bowel and omental involvement as well as on the expertise of the surgeon. Because of increased postoperative morbidity and mortality, it is not advisable to leave the placenta in situ [13]. In this case, because of the involvement of the broad ligament on the right side with distortion of the ovary and tube on the same side and extension of part of the placenta to small portion of the sigmoid colon posteriorly the decision was made intraoperatively for a supracervical hysterectomy to obtain adequate hemostasis. In our case massive transfusion protocol was applied as per hospital protocol [14].

4. Conclusion

A high index of suspicion and recognition of signs and symptoms are therefore detrimental to diagnosis and guide to a prompt surgical emergency. In patients with acute symptoms and lack of prenatal care, abdominal pregnancy should always be a differential.

Prompt delivery of the fetus, followed by and control of hemorrhage and decision of placenta removal are the greatest challenges. Adequate personnel including anesthesia, pediatricians, and general surgeons may be necessary for a successful management.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

How Your Fetus Grows During Pregnancy

Cell: The smallest unit of a structure in the body. Cells are the building blocks for all parts of the body.

Egg: The female reproductive cell made in and released from the ovaries. Also called the ovum.

Embryo: The stage of development that starts at fertilization (joining of an egg and sperm) and lasts up to 8 weeks.

Fallopian Tube: One of a pair of tubes through which an egg travels from the ovary to the uterus.

Fertilization: A multistep process that joins the egg and the sperm.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Genitals: The sexual or reproductive organs.

Gestational Age: How far along a woman is in her pregnancy, usually reported in weeks and days.

Hormones: Substances made in the body that control the function of cells or organs.

In Vitro Fertilization (IVF): A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Lanugo: Soft, downy hair that covers the fetus’s body.

Last Menstrual Period (LMP): The date of the first day of the last menstrual period before pregnancy. The LMP is used to estimate the date of delivery.

Oxygen: An element that we breathe in to sustain life.

Placenta: An organ that provides nutrients to and takes waste away from the fetus.

Scrotum: The external genital sac in the male that contains the testicles.

Sperm: A cell made in the male testicles that can fertilize a female egg.

Surfactant: A substance made by cells in the lungs. This substance helps keep the lungs elastic and keeps them from collapsing.

Testicles: Paired male organs that make sperm and the male sex hormone testosterone. Also called testes.

Trimesters: The 3-month periods of time in pregnancy. They are referred to as first, second, or third.

Ultrasound Exam: A test in which sound waves are used to examine inner parts of the body. During pregnancy, ultrasound can be used to check the fetus.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

The curious case of the stone baby

By Diane Mapes

While a 92-year-old woman delivering a 60-year-old baby may sound like a bizarre plot twist from the movie “Benjamin Button,” it’s true. Huang Yijun, 92, of southern China, recently delivered a child which she’d been carrying for well over half a century.

The baby wasn’t alive, however. The woman was carrying a lithopedion — or stone baby. It’s a rare phenomenon that occurs when a pregnancy fails and the fetus calcifies while still in the mother’s body.

According to Dr. Natalie Burger, endocrinologist and fertility specialist at Texas Fertility Center, lithopedions start off as ectopic pregnancies, a condition where the fertilized egg gets stuck on its way to the womb, implants and develops outside the uterus.

“Usually an ectopic pregnancy will mean a [fallopian] tubal pregnancy, but in a small percentage of cases, the pregnancy can actually occur in the abdominal cavity — in places like the bowel, the ovary, or even on the aorta,” she says. “These are very rare locations and they can be very dangerous.”

In most cases, Burger says, doctors will recommend the pregnancy be terminated due to the extreme risk to the mother. Or the fetus will simply die on its own due to a lack of blood supply.

“The vast majority never get anywhere close to multiple months of pregnancy,” she says. “They die, the tissue breaks down and they’re gone.”

In certain cases, however, the implanted fetus gets to an advanced stage before it dies. Too large to be absorbed by the body, the remains of the child or its surrounding amniotic sac slowly calcify, turning to stone as a way to protect the woman’s body from infection from the decomposing tissue. Because the mother’s body doesn’t recognize the hardening mass as foreign, if there are no other complications she can basically just go on with her life.

Stone babies are extremely rare, but you wouldn’t know it considering how often they’ve been used as a plot device in novels, short stories and TV shows. For example, in recent years, they’ve shown up on “Law & Order: Criminal Intent,” “Nip/Tuck” and the Australian series, “All Saints.” Maybe calcified babies are so popular because they tap into a mythological fascination with or deep fear of a soft, innocent body turning to stone.

According to a 1996 paper in the Journal of the Royal Society of Medicine, only 290 cases of lithopedion have ever been documented by medical literature, the earliest being that of a 68-year-old French woman Madame Colombe Chatri who, when autopsied after her death in 1582, was found to be carrying a fully-developed stone baby in her abdominal cavity. Chatri, whose abdomen was said to be “swollen, hard and painful throughout her life,” had been carrying her stone child for 28 years.

The mean duration of a “stone pregnancy,” according to the Journal article, is 22 years. Some women, such as China’s Huang Yijun, have carried their calcified fetuses for more than 50 years.

How could a woman walk around with a stone baby for years and years and not realize something was amiss?

“In some cases, there would be symptoms of an early pregnancy and then they would go away,” says Burger. “The women would just think they just lost a pregnancy and wouldn’t think any more of it.”

In other cases, a lack of money or medical resources comes into play. Huang Yijun told reporters she didn’t have the money to have her fetus removed after doctors told her it had died inside her in 1948. So, she simply “did nothing and ignored it.”

Other women, particularly those living in countries where obstetric care isn’t readily available, are unaware of their condition until the calcified mass causes a serious health issue. According to Burger, lithopedions — which can weigh up to nine pounds in the case of a full-grown fetus — have been known to cause intestinal obstruction, pelvic abscess, problems with delivery in future pregnancy and fertility issues, among other things.

They’ve also been known to cause quite the public sensation.

In 1582, the autopsy findings of Madame Chatri – complete with illustrations depicting the woman and her stone child — became an instant medical bestseller and the calcified fetus was quickly sold to a wealthy French merchant (sort of the P.T. Barnum of his day) who put it on display at his museum of curiosities in Paris. The fossilized fetus reportedly changed hands several times after that, finally ending up in the King of Denmark’s royal museum in 1653. Two hundred years later, the museum was dissolved and the stone fetus was transferred to the Danish Museum of Natural History.

Several years after that, the stone baby was lost. Or perhaps laid to rest, at long last.

BBC NEWS | Health | Miracle baby ‘grew in liver’




The baby developed outside the womb

A healthy baby has been born after developing in its mother’s liver instead of in the womb.


Reports from South Africa say Nhlahla, whose name means “luck” in Zulu, is only the fourth baby ever to survive such a pregnancy.


In all, there have only been 14 documented cases of a child developing in this way.


Nhlahla was born after specialists performed a difficult operation to deliver her on Tuesday.







The mother is at a huge risk







Professor James Walker, Ectopic Pregnancy Trust,




She had to be put on oxygen after her birth, where she weighed a healthy 2.8kg, but was breathing without aid by Thursday.


Doctors said Nhlahla and her mother Ncise Cwayita, 20 – whose first baby was born normally – were both doing well.


Liver specialist Professor Jack Krige, who helped deliver the baby, told a South African newspaper: “She is the real thing. She is truly a miracle baby.”


Risks


When an egg is fertilised, it normally travels down the fallopian tube to the womb, where it implants and grows.


But sometimes, the embryo implants in the fallopian tube, a standard ectopic pregnancy.


In some cases – around one in 100,000 pregnancies – it falls out of the fallopian tube and can implant anywhere in the abdomen.


In extremely rare cases, such as this one, the embryo attaches itself to the liver, a very rich source of blood.


The baby is protected because it is within the placenta – but it does not have the usual protection of the womb – and is at more risk in the abdominal cavity.


Most babies in extrauterine (out of the uterus) pregnancies die within a few weeks.


Window


In this case, doctors only discovered the baby was growing in the liver when they performed a scan this week.


Her womb was found to be empty, even though her baby was due in a week.


Ms Cwayita was transferred to the Groote Schuur Hospital in Cape Town.


Dr Bruce Howard told the Cape Argus newspaper said: “We knew it was an extrauterine pregnancy but we didn’t know it was in the liver until we started the operation on Tuesday morning.”


Doctors found a small “window” where the amniotic sac connected with the outside of the liver where they were able to go in to deliver the baby.


Doctors had to leave the placenta and amniotic sac in the liver, because the mother’s life would have been at risk.


It is expected they will be absorbed back into her body.


Professor James Walker, president of the British Ectopic Pregnancy Trust, told BBC News Online abdominal pregnancies could be very dangerous.


“The mother is at a huge risk. One in 200 women die before we can do anything to help them.


“The main problem for the baby is that it is not protected by the muscular wall of the womb.”





90,000 In Voronezh, doctors rescued a child born outside the uterus – Rossiyskaya Gazeta

A unique operation was performed in the regional perinatal center to save the life of a woman with an ectopic pregnancy. This pathology almost always leads to the death of the fetus, and often the mother. In Voronezh, the child was born healthy.

The woman, who already has two children, did not know about a new pregnancy for a long time and did not register, according to the regional health department.

The fetus did not develop in the uterus, but in the abdominal cavity.Feeling the baby’s stirring, the mother went to the doctor at the place of residence – in the Bogucharsky district hospital. The ultrasound did not show where the child was located: the tissues surrounding the fetus created the appearance of a normal uterus.

According to the deputy chief physician for obstetrics and gynecology of the regional clinical hospital No. 1 Sergei Khots, the woman’s condition caused anxiety among district obstetricians, so they consulted with colleagues from Voronezh on telemedicine communication. Then the pregnant woman was promptly taken to the perinatal center.

There they carried out a complex operation to retrieve the baby. A girl weighing 2,150 grams and a height of 46 centimeters was born late in the evening on January 17. She is alive and well. The unusual childbirth was not easy for the woman, she had to transfuse three liters of blood.

“Now mom and baby are feeling well and are preparing for discharge. The newborn is the third child now in a large family. Congratulations to the happy parents and the entire staff of the perinatal center,” added the health department.

According to Olga Samofalova, chief obstetrician-gynecologist of the Voronezh region, the case is outstanding even by world standards. Ectopic pregnancies occur in one to two cases out of 100, and the probability that the fetus will form in the abdominal cavity is 1.4 percent. As a rule, the child is not viable. In 40-95 percent of cases, he dies at the beginning or middle of pregnancy. Every fifth mother dies with such an arrangement of the fetus.

90,000 In Voronezh, a mother carried her baby outside the womb and successfully gave birth

In Voronezh, a mother gave birth to a healthy child with an ectopic pregnancy.This was reported by the press service of the regional health department. The fetus developed in the woman’s abdominal cavity.

A mother who already has two children did not know for some time that she was carrying a third child. Therefore, I did not register at the antenatal clinic. When she felt the first movements of the fetus, she turned to the Bogucharsk regional hospital. “It was not possible to determine the unusual localization even with the help of ultrasound. World practice shows that it is very difficult to assume an abdominal pregnancy, since the tissues surrounding the fetus create the appearance of a normal uterus, ”the regional health department noted.Obstetricians from Boguchar consulted with the doctors of the perinatal center, and then took the patient to Voronezh.

It happened on January 17, but the doctors released the information only a few days ago. On that day, at 22:30, the doctors of the perinatal center of VOKB No. 1 performed a serious operation: the girl was born healthy, weighing 2150 g and growing 46 cm. The woman in labor was transfused with 3 liters of blood. At the moment, the mother and daughter are doing well, they are being prepared for discharge.

Such a case of ectopic fetal bearing is unique; only 3 such cases in world practice are described in the medical literature.This was told by the chief freelance neonatologist of the regional health department, doctor of medical sciences, professor, chairman of the Voronezh Regional Duma Committee on Labor and Social Protection of the Population Lyudmila Ippolitova.

“A rupture could occur at any moment, and the fact that in this case the child dies is 100%, and in order to save a woman from profuse bleeding, the doctors would have had literally 7-10 minutes,” said Lyudmila Ippolitova. After a successful operation, the child was 5 days in intensive care under dynamic observation, but the situation did not require serious invasive manipulations.The child received light respiratory support with oxygen. On the 6th day, the baby was transferred to the second stage of nursing.

“… The case is unique in that the mother brought the pregnancy outside the uterus to such a gestational period – 34-35 weeks, fully corresponds to her gestational age – that is, the child’s physical parameters correspond to the age at which he was born,” – explained Lyudmila Ippolitova.

The child is diagnosed with grade 1 prematurity, but the baby has no external and internal changes or pathologies – he was fully examined.

Chief obstetrician-gynecologist of the regional health department Olga Samofalova confirmed the uniqueness of the incident. According to statistics, pregnancy in the abdominal cavity outside the uterus occurs in about 1.4% of cases of ectopic pregnancies. And ectopic localization is no more than 1-2% of all pregnancies. Most often, bearing a child in the abdominal cavity ends badly: very rarely, the fetus is eventually viable. According to the department, in 40-95% of cases, he dies at the beginning or middle of pregnancy.And maternal mortality with the localization of pregnancy in the abdominal cavity reaches 20%.

A 38-year-old woman from the Voronezh region herself, who was carrying a fetus in the abdominal cavity, spoke about the course of her pregnancy and her daughter.

“There were no suspicions at all. When I felt discomfort, I went to the hospital. When the ultrasound was done, it turned out that it was already 34 weeks pregnant, she says. – The first two weeks were overwhelmed with emotions, I could not believe that this happens.Now I’m used to it. Thank you very much to the doctors for saving me, constantly supporting me and not leaving me for a minute after such a difficult operation. Now I feel good, on Tuesday we are getting ready to be discharged. ”

Evgenia Baturina and her husband decided to name their daughter Anastasia. Also, the mother said that now her eldest daughter is 19 years old, her second son is 6. Evgenia admits that the message about pregnancy was a big surprise for the whole family.

Published in the newspaper “Moskovsky Komsomolets” No. 7 of February 11, 2020

Newspaper headline:
Unique baby

Error during IVF.A couple in the United States, who had someone else’s child, is suing a clinic that confused embryos

Photo author, Peiffer Wolf Carr Kane & Conway

Photo caption,

According to Daphne and Alexander, they were first of all alarmed the appearance of the newborn – she was much darker than any member of their family

As a result of an error during an in vitro fertilization procedure, two couples in California gave birth to biologically alien children.Now the parents of one of the kids have filed a lawsuit against the doctors, demanding compensation for the moral and psychological suffering caused to them.

The second affected couple wished to remain anonymous, while the other – Daphne and Alexander Cardinale – made their story known to the press, explaining that such cases occur periodically, and it is no longer possible to remain silent about them.

They sued the California Center for Reproductive Health, where the birth took place, as well as its affiliated laboratory, In VitroTech Labs.Plaintiffs say they were victims of medical error, negligence and willful concealment of medical error. The clinic and laboratory did not respond to a request from the BBC for comment.

According to the family’s lawyer, another affected couple is also going to sue.

In vitro fertilization is a procedure in which an egg is fertilized outside the uterus, in laboratory conditions, and a few days later the embryo is transferred into the body of the mother, who bears the baby before giving birth.

How the events developed

The lawsuit says that Daphne and Alexander contacted the California Center for Reproductive Medicine in the summer of 2018. The next year they had a child, but the husband suspected something was wrong from the very first minute.

Photo author, Getty Images

Alexander Cardinale explains that he expected to see a “fair skinned baby” like their firstborn. However, the father was surprised to find that the newborn girl “turned out to be much darker-skinned, with jet-black hair,” the lawsuit notes.

“It was so unexpected and strange that Alexander even moved a few steps away from the birthing chair and leaned his back against the wall,” the lawyers write. “Over the next weeks, Alexander could not get rid of the thoughts of the unexpected appearance of their daughter. it looks like she belongs to a different race, which looked completely out of place in light of the origin of Daphne and Alexander. ”

As stated in the lawsuit, Alexander constantly spoke to Daphne about his doubts that the child born was really their biological daughter, and this was extremely upsetting for the mother.By this point, Daphne had convinced herself that the baby was like her in infancy, because right after birth she also had jet-dark straight hair. “However, doubts did not leave her, and she constantly looked in the mirror, trying to find common features with her daughter,” the authors of the lawsuit say.

In the end, about two months after giving birth, Daphne got tired of listening to her husband’s conversations and decided to do a DNA test that will answer all the questions. The analysis showed that the child is not genetically connected in any way with Daphne and Alexander.“I had the feeling that the walls began to move in the room, a fog appeared in front of my eyes, I was just numb,” – this is how the mother describes her reaction to the test results.

After that, the California clinic helped the Cardinale family find another couple who carried their biological child – this girl was born a week later. When the comrades in misfortune first met, their children were about four months old. After a few more meetings, they decided to exchange daughters – and did so in January 2020, having gone through the necessary legal formalities.

“Pain and Confusion”

Although the children were reunited with their biological parents as a result, Daphne and Alexander say that this whole story was very difficult for them. On Monday, Daphne Cardinale held a press conference at which she said that their “pain and confusion cannot be underestimated.”

“Our memories of childbirth will now be forever darkened by the terrible fact that our biological child was given to other people, and I will not be able to be with the baby, which was born thanks to my efforts,” she said.“My ability to carry my own child was stolen,” explains Daphne.

In an interview with CBS, she said that the desire to get her child back was as strong as the fear of losing the one she physically gave birth to. “Instead of breastfeeding my own child, I nursed and became close to the baby, which I later had to give up,” the woman says.

She adds that it was even more difficult for their eldest seven-year-old daughter, who could not understand why she suddenly had another sister.

All family members developed anxiety and depression symptoms of varying severity and are now undergoing psychotherapy.

This is not the first time in the world when an embryo is replaced during IVF. In 2019, another family in California discovered that their child was actually born in New York. The couple sued the woman who gave birth to the child, who reportedly did not want to give it up. By court order, the baby was transferred to the genetic parents.

Fourth month of pregnancy | Friso Russia

What’s going on with mom?

By the 4th month, the uterus is significantly enlarged.It fills the pelvis and begins to grow up towards the belly. Due to the fact that she changes her position, urination will be less frequent. Constipation is possible as bowel function slows down during pregnancy. The lungs, heart and kidneys work harder as blood circulation in the body increases.

There will be other changes in your body. The growing fetus needs a lot of blood, which sometimes leads to nosebleeds, varicose veins.Your state of health improves: if in the first trimester you were tormented by nausea, vomiting, now it goes away. In general, this is the calmest time for a woman. The mood improves and the working capacity increases, and not too big a belly allows you to move quite actively and even relax at sea (without long-distance flights). The child is reliably protected by the placenta, and besides, he has grown and got stronger. Of course, you need to be careful, but in general, it is in the 4th month that you can get the most pleasant pregnancy experience.

It is with this month that many mothers have a pleasant discovery: you will feel the first movements of the fetus in the uterus. These sensations are very peculiar, they are usually compared with weak trembling, fluttering in the abdomen, but also with gas movements, gurgling of liquid. The baby will move more and more, so you will recognize them and be able to distinguish them.

How is the baby developing?

At the end of this stage, the growth of the fetus is 10-16 cm. It already looks like a fully formed child, although it cannot still live outside the uterus.The neck developed, the joints of the arms and legs formed, and the bones began to harden. The fetus has eyebrows and eyelashes, on the fingers – its own unique pattern. In the same period, the head grows more actively, acquiring disproportionately large sizes in comparison with the body. The child develops the rudiments of teeth. Interestingly, the fetus is already beginning to develop reflexes: it learns to suck and swallow. On the screen of the monitor of an ultrasound machine, doctors often observe how the baby swallows amniotic fluid with his mouth.

Sometimes, at a period of 12-14 weeks using ultrasound, it is already possible to determine the sex of the unborn child.

Tip:

Get in the habit of sleeping on your left side, as this promotes blood circulation. Lying on your back or stomach after the fourth to fifth month can increase pressure on the growing fetus and obstruct blood flow to the fetus. Try placing a pillow under your side and between your legs when you go to bed. Some firms make maternity pillows that provide support for the entire body.

90,000 unique stories of childbirth “- Yandex.Qu

Contents

Ectopic pregnancy is always pathological, the child must develop in the uterine cavity. There are all conditions for proper and full growth and nutrition of the fetus. However, in about 2% of cases, the fertilized egg does not enter the uterus and begins to develop outside of it. Most often, such a pregnancy occurs in the fallopian tube, but there are other cases of oocyte attachment.

In any case, an ectopic pregnancy is the highest risk not only for the child, but also for the mother. However, medicine knows several cases when such pregnancies ended quite successfully. How did this happen?

Causes of an ectopic pregnancy

Most cases of ectopic pregnancies are tubal. Fertilization of the egg normally occurs in the cavity of the fallopian tube, and then the blastula is sent to the uterus and there it is already implanted into its wall.In a tubal pregnancy, the embryo remains in the tube that leads from the ovary to the uterus.

Although tubal pregnancy is the most common type of ectopic embryo implantation, attachment can also be to the surface of the ovary, and even to tissues and organs of the abdominal cavity, for example, to the intestinal wall. Then the diagnosis is “abdominal pregnancy”.

The danger of such pregnancy lies in complications that are almost impossible to avoid. With extremely rare exceptions, an ectopic pregnancy ends in fetal death, and without timely intervention it threatens with serious complications for the woman’s health and life.For this reason, when the incorrect localization of embryo implantation is established, the woman is referred for an abortion.

Most often, an ectopic pregnancy is diagnosed with obstruction of the fallopian tubes and adhesions in the abdominal cavity. In the high-risk group – pregnant women after surgery on the gallbladder, uterus, appendix, etc. The risk is also increased by inflammation due to diseases (chlamydia, endometriosis, gonorrhea) and hormonal imbalances.

Patients with an ectopic pregnancy often ask the question: is it really impossible to “transfer” or “move” an embryo into the uterine cavity in the age of in vitro fertilization and modern reproductive technologies?

There are two problems.First, there are no technologies for the “transfer” of an implanted embryo from one tissue to another. Secondly, due to implantation in the wrong place, the body of the uterus cannot prepare to receive the embryo, since structural changes develop and the production of hormones does not correspond to the required norm.

Pregnancy or appendicitis?

The first signs of an ectopic pregnancy are exactly the same as usual. There are no specific symptoms until 6-8 weeks. But the longer the period, the higher the likelihood of the onset of a dangerous process with its own signs: sharp pain at the place of attachment of the embryo.If it was implanted in a tube or on the ovary, then the pain will be in the lower abdomen, in other cases – in the center or side. The attacks of pain are also accompanied by low blood pressure up to fainting, bradycardia, and such a “blurred” clinical picture forces doctors to suggest three diagnoses: ectopic pregnancy, ovarian apoplexy or appendicitis. All these options are assumed in the early stages, especially if a woman does not know about her condition. But there are other situations as well.

Oksana Kuzhevatova, a Russian woman at the age of 37, was expecting her first child and the entire pregnancy was monitored by a antenatal clinic.Neither the baby nor the mother had any problems, and Oksana was waiting for the birth. However, everything turned out differently.

At 37 weeks, she developed severe abdominal pain, and after hospitalization, the doctors suggested that the cause was appendicitis. This means that an operation is needed.

However, during the operation it turned out that there was no inflammation of the appendix. But Oksana’s son was not in the uterus, but in the abdominal cavity. Obstetricians-gynecologists joined the operation on an emergency basis.

As a result of an unusual caesarean section, a boy 51 cm tall and weighing 2750 g was born.The kid had to spend several hours on a ventilator, and then he began to breathe on his own. Today Oksana and baby Arseniy are healthy and well.

How it happened that the baby was able to develop as much as 37 weeks outside the uterus is not clear. The fertilized egg adhered to the right epididymis, most likely through a damaged fallopian tube. Despite regular examinations, ultrasound did not show the whole picture. Obstetrician-gynecologist Elena Aleksandrova, who eventually performed the operative delivery, explains that the reason is in the transverse presentation of the baby and the “inconvenient” location of the placenta.The case turned out to be very difficult even for professional diagnosticians.

Abdominal pregnancies and premature birth

Baby Arseny, who developed outside the uterus up to 37 weeks, is a wonderful and isolated case in world practice. Science knows only about ten such pregnancy outcomes that can be called successful. More often than not, an abdominal pregnancy ends much earlier.

The emergence of a healthy child as a result of an abdominal pregnancy is always a significant event in the world of medicine.For example, we know of a case in Tanzania where Dr. Dismas Matovelo helped to give birth to a girl weighing 1.7 kg. It developed in the mother’s abdominal cavity for 32 weeks, after which complications, pain, anemia, and internal bleeding in the expectant mother began.

One of the first registered abdominal pregnancies with good outcomes was reported in 1999 in the United States, Utah. Due to an error in the ultrasound, the localization of the fetus outside the uterus was overlooked, and the woman brought the child until the planned cesarean section, where the peculiarities of pregnancy were clarified.In Europe, the same happened in 2008: Jane Jones had a son, Billy, who developed on the surface of the colon

“I dreamed of a child and did not worry”

A unique case of ectopic pregnancy, which ended in a successful delivery, was noted by the doctors of the Altai Perinatal Center. Inna moved to Barnaul from Donbass and was already settling in when it turned out that she was pregnant. The first and long-awaited baby at the age of 31 did not force her mother to start visiting doctors, she “dreamed of a child and did not worry.”And only for a period of 41 weeks I decided to do an ultrasound examination.

A doctor at a private clinic saw an extremely strange picture: a large fetus in the abdominal cavity, and sent the expectant mother to the perinatal center. It was only there that Inna realized how serious the whole situation was: a whole council of doctors had to be assembled to assess the risks. Experts assumed several variants of pathology, the main one was the central presentation of the placenta. The size and age of the child indicated that such a pregnancy could not be ectopic.

Vladimir Borovkov , deputy chief physician of the Altai Perinatal Center, says that the diagnosis of “abdominal pregnancy” was made already during the caesarean section. If this pathology had been identified earlier, the pregnancy would have been terminated, but the patient avoided doctors. The danger of such cases is extremely high: due to internal bleeding, the lives of not only the fetus, but also the mother are interrupted.

“During my more than twenty years of medical practice, there were only 4 similar cases, and patients had to be rescued early in gestation.Only in two cases was it possible to save children in a state of severe prematurity. ”

The uniqueness of Inna’s situation also lies in the fact that the baby was not only full-term, but also turned out to be very large – 4,160 g. To help him be born, a team of 9 specialists was needed.

Output

Although such miracles do happen, there are no more than a dozen of them registered in the world. Thousands of times more cases of death of mother and baby due to developing ectopic pregnancy, which women, for some reason, decided not to interrupt.MedAboutMe advises everyone who is in a similar situation to undergo an expert ultrasound scan and make the right decision in order to maintain health, live and have children in the future.

Photo materials used Shutterstock

Sources used

  1. Features of the clinical course of ectopic pregnancy / Kaushanskaya L.V. // Russian Bulletin of Obstetrician-Gynecologist. = 2008. – No. 4. T. 8.
  2. Modern technologies in the diagnosis of ectopic pregnancy at the hospital stage / Kaushanskaya L.V., Salov I.A. // Saratov Journal of Medical Scientific Research. = 2009. – No. 4. T. 5.
  3. Errors in the diagnosis of tubal pregnancy / Tvaradze I.E., Shtyrov S.V., Lugueva A.Yu., Demidov A.V. // Reproduction problems: spec. no. Technologies of the XXI century. = 2008

Material provided

medaboutme.ru

Pregnancy: Terrible word THREAT! Let’s save ourselves!

Our today’s conversation will touch upon the recommendations for a pregnant woman who is faced with such a complication of pregnancy as the threat of termination.

Pregnancy is a physiological process for the female body. If a woman is young (18-30 years old) and healthy, then, as a rule, pregnancy proceeds without complications. Recently, in the world and in our country, there has been a sharp deterioration in the health of women of reproductive age.

Complications of pregnancy for a better understanding of the reader can be divided into 3 groups (these are not standards).

  • First, the complications associated with the pregnancy itself, if it were not for this condition, then there would be no complications – the threat of termination of pregnancy (the threat of premature birth).
  • Secondly, these are complications associated with a disease (eg rubella) arising during pregnancy.
  • Thirdly, these are complications that have arisen in a woman who suffered from this or that disease even before pregnancy (perhaps the first exacerbation of this disease is associated with pregnancy).

The most unpleasant psychological and physical complications are the threat of termination of pregnancy . If this occurs in the early stages, then the term is used threat of termination of pregnancy “, if at a later date (after 28 weeks), then ” threat of premature birth “.

What to do if there is a threat of termination of pregnancy

In some countries, including Russia, it is customary to maintain pregnancy of any period; accordingly, if a woman notes spotting during pregnancy, then she immediately should see a doctor in the daytime or resort to the help of an emergency team at night. But the question of the advisability of maintaining pregnancy with the onset of bleeding up to 12 weeks remains open, i.e.It is known that 70-80% of pregnancies terminated during this period are associated with chromosomal pathologies, sometimes incompatible with life. Those. we can say that the body itself corrects its mistakes.

Reasons for termination of pregnancy

Termination of pregnancy can be associated with cervical incompetence . Those. its upper part may not be tightly closed, i.e. unable to play the role of a “castle”. This condition can be caused by trauma during a previous birth or during abortion ( even if it was a one-time ).In this case, treatment is carried out in a hospital, and in the future, pregnancy is observed by an outpatient doctor. A woman can have a suture on the cervix if such a diagnosis is made at 16-20 weeks or a special retaining ring is placed if complaints appear later than this period. The suture or ring is removed at the time of the onset of labor, i.e. with the appearance of regular contractions or outpouring of amniotic fluid. However, this procedure can be performed up to two weeks before the expected date of delivery.

Termination of pregnancy can be associated with hormonal status of a woman , therefore hormones play a leading role in the treatment of this complication. In order to clarify the diagnosis in the antenatal clinic, they can take the so-called “threat smear” (this is not 100% confirmation of the diagnosis). Of course, hormones play one of the main roles in the regulation of pregnancy. The problem of miscarriage treatment is very complex and multifaceted. I repeat that in our country it is customary to preserve early pregnancy.For this purpose, hormonal therapy is used, based on the physiological and pathogenetic processes of the onset and development of pregnancy. A woman diagnosed with threatened miscarriage or threatened termination of pregnancy is hospitalized for appropriate therapy in a serious condition, or can be monitored on an outpatient basis and given hormone therapy, as in inpatient treatment.

Symptoms of threatened termination of pregnancy

As for the threat of premature birth, the first symptoms may not be spotting, but simply profuse discharge (sometimes a woman thinks that she has urinary incontinence).This may be a signal that the integrity of the fetal bladder is compromised. Of course, in this case, you should immediately consult a doctor. If it is daytime, then an antenatal clinic is enough. At night, it is better to call an ambulance team or get to the maternity hospital on your own.

In the later stages of pregnancy, there may also be spotting . The reason for them may be a low-lying placenta and constant uterine contractions (uterine tone).It is the tone of the uterus that can cause placental abruption and, accordingly, bleeding. Seeing a doctor should be in the same way as described above.

Separately, it is necessary to mention about ectopic pregnancy . This condition can also be associated with the threat of termination, only the consequences of terminating an ectopic pregnancy can adversely affect a woman’s health. An ectopic pregnancy is a condition in which the ovum is attached outside the uterine cavity.This place is most often the tubes, but ectopic pregnancy can also be found directly in the ovary or in the abdominal cavity. The diagnosis of “ectopic pregnancy” requires immediate surgical intervention. The volume of the operation and the operative access (abdominal surgery or laparoscopic) can be resolved only in a hospital setting and depends on many factors, including complications that arose at the time of admission to the hospital. Very often, an ectopic pregnancy occurs when the villi, which are in the tubes and push the fertilized egg into the uterine cavity, are disrupted.It is impossible to predict this state. However, it can occur most often with chronic inflammatory diseases of the pelvic organs.

What to do in case of termination of pregnancy

If the pregnancy could not be saved, then the question arises about the reasons for this situation. After the incident, an examination is necessary, which will include an examination of both spouses. It is necessary to obtain results of histological examination and consult with geneticist .The woman will be examined by a gynecologist for the presence of infections or hormonal disorders, the man needs a consultation with a urologist (andrologist) for the same examination.

Sometimes it is very difficult to find the reason, but this is not a reason to despair. Subsequent pregnancies can go without complications, and the first failed attempt is quickly forgotten. With a safe examination , it is recommended to plan the next pregnancy in 4-6 months .

Everything that we talked about should draw attention to the health of a pregnant woman and help navigate when a particular situation arises.A desired pregnancy is a joyful state for a woman and her family. The task of the doctor is to prevent and, as far as possible, solve the problem with a positive result.

Doctors of the Fetal Medicine Center are one of the leading specialists in prenatal diagnostics, candidates of medical sciences, doctors of the highest categories, with a narrow specialization and extensive experience in prenatal medicine.

All ultrasound examinations at the center are carried out according to the international standards FMF (Fetal Medicine Foundation) and ISUOG (International Society of Ultrasound in Obstetrics and Gynecology).

Doctors of ultrasound diagnostics have international certificates of the Fetal Medicine Foundation (Fetal Medicine Foundation, Great Britain), which are confirmed annually by .

We take care of the most difficult cases and, if necessary, it is possible to consult with specialists from the Royal College Hospital, King’s College Hospital (London, UK).

The subject of pride of our Centers is modern and high-tech medical equipment from General Electric: Voluson E8 / E10 expert class ultrasound machines

The capabilities of these devices allow talking about a new level of information content.


Make an appointment

You can make an appointment and get an expert opinion from our specialists in ultrasound diagnostics by calling the single contact center +7 (812) 458-00-00

Artificial uterus – a tool for the liberation or dehumanization of women?

For some women, pregnancy and childbirth is a natural thing, a joyful and inspiring event; for others, it is a terrifying physical experience that requires taking full responsibility for the baby in the womb and for the process of its birth.

Some people consider blood, sweat and tears an integral part of life. Others, such as the radical feminist Shulamit Firestone, author of The Dialectic of Sex (1970), call the process “barbaric” and argue that giving birth is the same as “defecating a whole pumpkin.”

Most of us do not adhere to any of these positions and are more or less neutral about childbirth.

Whatever the attitude towards pregnancy and childbirth, the advent of artificial uterus technology (also known as ectogenesis) could completely change it.Firstly, this technology promises many medical benefits: women in whom pregnancy is proceeding with complications will be able to transfer the fetus into an artificial womb and reduce the risks for themselves and the baby; and premature embryos will be able to continue their development in an artificial uterus and be born on time. So the process of childbirth does not necessarily have to be accompanied by blood, sweat and tears.

Second, the artificial uterus technology can bring many social benefits to women.

Firestone believes that an artificial uterus will relieve women of social pressure and biological responsibility for procreation.

While gender differences remain a matter of debate, it is childbirth and the ideal of the nuclear family that are the main reason for unfair treatment of women. But with the advent of the artificial uterus, women will finally be able to freely pursue their interests and needs, freeing themselves from the oppression of reproductive responsibilities.

Even a cursory review of the medical and non-medical potential of an artificial uterus reveals many advantages of this technology. And if you consider how many people with its help can solve their reproductive problems, then its appearance will be a real miracle. In 2017, researchers successfully raised eight lamb embryos in special bags that mimic a sheep’s womb. The results of this experiment caused a large-scale discussion in society – they started talking about the possibility of using the new technology for people.

The Firestone position is supported by many contemporary feminists, for example the philosopher Anna Smidor in her work The Moral Imperative of Ectogenesis (2007). However, not everyone realizes that the possibilities of an artificial uterus for the emancipation of women are very limited. On the one hand, the artificial womb will ensure an equal distribution of reproductive labor; however, after childbirth, it is women who are responsible for feeding, expressing milk, and raising children. Moreover, those women who, by chance or knowingly, refuse these responsibilities are stigmatized by society.Therefore, it is not very clear how an artificial womb can protect women from psychological pressure.

This leads us to believe that the problem lies deeper.

The artificial uterus promises to save women from the oppression of motherhood, but it does not question the very patriarchal values ​​and worldview that makes feminists treat the reproductive process as a threat. It is possible that artificial uterus technology will undermine all efforts to free women.

In an essay published in the journal Aeon, the philosopher Suki Finn describes two metaphysical patterns in Western thinking about pregnancy. The first model can be called “organ-oriented”: it describes the embryo as a part of the body – a pregnant woman perceives the unborn child as one of her organs. The second model – “container-oriented” – dominates the public consciousness. According to this model, the embryo and the pregnant woman are perceived as two different entities.It is this attitude towards pregnancy that allows us to talk about the embryo as a “pie in the oven” or portray it as an astronaut in outer space.

Sociologist Amrita Pande in his study 2010, dedicated to the problem of surrogacy in India, showed what the perception of a pregnant woman and a child as separate entities leads to: in reproductive medicine clinics, dehumanizing prenatal practices are formed that devalue the work of surrogate mothers.

So if in the moral sense the perception of the mother as a container can be completely neutral, then in the cultural context such a concept takes on a serious patriarchal connotation.

The choice of obstetric practitioners depends on our conceptual understanding of the process of pregnancy and childbirth itself. For example, the very idea of ​​using artificial womb to replace some or all of the stages of gestation speaks to the perception of a pregnant woman as an incubator.

The feminist scientist Irina Aristarkhova offers an alternative point of view, according to which the technology of an artificial womb is becoming a more complex system.

If we consider the embryo as part of the gestating organism, this will seriously limit the possibilities of the artificial womb. Of course, we can create a new model of the relationship between the fetus and the gestating “container”: for example, a mechanical model that would fit the world of machines and robots.

Any technology based on a problematic view of pregnancy will lead to the normalization or aggravation of these very problems. In this context, the devaluation of the labor of bearing the fetus and the relationship between the mother and the embryo can be considered completely unethical.It cannot be denied that artificial womb technology can benefit a huge number of people regardless of their gender, but it is not worth speculating on this topic on the feminist agenda.

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