Successful Anesthetic Management Of Parturient With Advanced Abdominal Pregnancy
Abdominal pregnancy is a rare form of ectopic pregnancy associated with high mortality and morbidity for both the fetus and the mother. It is often observed in developing nations with poor outcomes as most cases result in fetal demise. We present a 48 year old parturient diagnosed with abdominal pregnancy who elected to continue the pregnancy despite the communicated risks. The patient was admitted to the hospital at 24 weeks of gestational age for antepartum observation with the goal of surgical delivery at 28 weeks of gestation. General anesthesia was provided with multiple large bore intravenous access in anticipation of hemorrhage. The surgeons were able to deliver a viable neonate and the patient did well with moderate blood loss successfully managed with tranexamic acid, crystalloid fluid, and blood products. She was extubated immediately in the operating room and was discharged on postoperative day 4 with no issues.
Abdominal pregnancy is an extremely rare form of ectopic pregnancy where implantation of fertilized ovum occurs directly in the abdominal cavity. The prevalence of ectopic pregnancy is 1-2% with 95% occurring in the fallopian tube. The incidence of ectopic pregnancy occurring in the abdomen is even more uncommon with incidence ranging from 1:1000 to 1:30,000 and mostly seen in developing nations. First documented case of abdominal pregnancy was in 1708 where the diagnosis was made based on excessive hemorrhage during a laparotomy. Similar case reports demonstrated the fatal risks associated with abdominal pregnancy as majority of cases resulted in extraction of the dead fetus with high rate of maternal mortality. The mortality rate associated with abdominal pregnancy is seven times higher than general ectopic pregnancy and 90 times higher than delivery in the third trimester.
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