Innovative use of tourniquet in the management of an advanced abdominal pregnancy to achieve an unusually normal postoperative outcome: a case report

Authors

  • Emmanuel C. Inyang Etoh Department of Obstetrics and Gynecology, University of Uyo, Nigeria
  • Iniobong E. Ettete Department of Obstetrics and Gynecology, University of Uyo, Nigeria
  • Christian A. Adeneye Department of Obstetrics and Gynecology, University of Uyo Teaching Hospital, Nigeria
  • Imaobong O. Inwang Department of Obstetrics and Gynecology, University of Uyo Teaching Hospital, Nigeria
  • Augustine V. Umoh Department of Obstetrics and Gynecology, University of Uyo, Nigeria

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20200919

Keywords:

Abdominal pregnancy, Complete removal of placenta, Minimal hemorrhage, Tourniquet application, Uneventful postoperative period

Abstract

Mrs. UVG was an un-booked G3P1+1 petty trader, who presented with an obstetric ultrasound scan report, with an incidental diagnosis of abdominal pregnancy at 32 weeks of gestation with the placenta attached to the fundus of the uterus. Her admission packed cell volume was 24%. She had pre-operative preparation and 2 units of compatible blood were transfused to correct the anemia. Four additional units of compatible blood were made available before she was scheduled for an exploratory laparotomy at 33 weeks of gestation. A grossly normal male infant weighing 2.2 kg was delivered from the peritoneal cavity with Apgar scores of 2 at 1 minute and the same at 5 minutes. The placenta which was attached to the fundus of the uterus was removed manually completely after a tourniquet had been applied distal to the point of separation. Intra-operative blood loss was 1000 ml. The infant died 1 hour after delivery due to respiratory failure. Autopsy report revealed massive intracerebral hemorrhage and pulmonary hypoplasia. The post-operative period was uneventful and the decline in serum assay of β-human chorionic gonadotrophin postpartum was normal. She was discharged home on the 8th post-operative day and seen at the postnatal clinic twice at weekly intervals with normal serum assay of β-human chorionic gonadotrophin. Her 6 weeks postnatal visit was also uneventful.

References

Atrash HK, Friede A, Hogue CJR. Abdominal pregnancy in the United States: frequency and maternal mortality. Obstet Gynecol. 1987;69(3,1):333-7.

Gibbs RS. Incidence of abdominal pregnancy. In: Gibba RS. (Ed.) Danforths Obstetrics and Gynaecology. Lippincott Willcame and Wilkins, Philadelphia; 2008:84.

Gabkika BM, Ignome T, Diarra D. Abdominal pregnancy with a live fetus at term at the South N’djamena district hospital. A case study. Sudan J Med Sci. 2015;10(2):77-80.

Mutarambirwa HD, Kenfack B, Fongon JT. Term abdominal pregnancy revealed by amnioperitoneum in rural area. Case Rep Obstet Hynecol. 2017;4096783:1-7.

Isah AY, Ahmed Y, Nwobodo EI, Ekele BA. Abdominal pregnancy with a full-term live fetus: case report. Ann African Med. 2008;4(7):198-9.

Hamdan M, Rousseau G, Wagner J. Abdominal pregnancy. An autochtonous case with full term living normal infant. J de Chirurgie. 1991;128(12):544-7.

Abdullahi HM, Yakasai IA, Zakari M, Shuaibu DS. Late presentation of advanced abdominal pregnancy with a live baby: a case report and literature review. Nigerian J Basic Clin Sci. 2013;1(10):25-8.

Ejikeme BN, Umeora OUJ, Mbazor JO, Egwuatu VE. Abdominal pregnancy presenting with antepartum haemorhage: a case report. Sahel Med J. 2006;2(9):69-70.

Huang K, Song L, Wang L, Gao Z, Meng Y, Lu Y. Advanced abdominal pregnancy: an increasingly challenging clinical concern for obstetricians. Int J Clin Exp Pathol. 2014;7(9):5461-72.

Agarwal N, Odejinmi F. Early abdominal ectopic pregnancy: challenges, update and review of current management. The Obstet Gynaecol. 2014;16:193-8.

Mengistu Z, Getachew A, Adefris M, Musinguzi E. Term abdominal pregnancy: a case report. J Med Case Rep. 2015;9:168.

Osanyim GE, Okunade KS, Oye-Adeniran BA. A case report of a successfully managed advanced abdominal pregnancy with favorable feto maternal outcomes. TJOG. 2017;3(34):240-2.

Baffoe P, Fofie C, Gandau BN. Term abdominal pregnancy with healthy newborn: a case report. Ghana Med J. 2011;2(46):81-3.

Downloads

Published

2020-02-27

Issue

Section

Case Reports