[Diagnosis and current concepts of management of advanced abdominal pregnancy].
Authors report a case of abdominal pregnancy diagnosed by MRI at 17 SA with prospective follow-up and planned delivery at 37 SA. The diagnosis is clinically suspected when extra-uterine pregnancy risk factors or history of uterine trauma are present. This is confirmed by MRI, which may be considered as the gold standard. A conservative management may be proposed when the diagnosis is made after 20 weeks and under the following conditions: absence of fetal growth malformation, placental implantation remote from the upper abdomen, good maternal condition, close management in a hospital setting of the patient previously informed of the risks and outcomes. Placental location on the uterus seems to be a major positive factor of outcome for these pregnancies. Materno-fetal follow-up is based on physical examination, repeated ultrasonic investigations with Doppler imaging and daily fetal heart rate monitoring. In the absence of complications, a laparotomy should be planned at 34 weeks. The placenta may not be removed when a serious risk of hemorrhage is feared.
Beddock
R
R
Centre de gynécologie et obstétrique, CHU d'Amiens, 124, rue Camille-Desmoulins, 80054 Amiens 1, France. r.beddock@hopital-foch.org
Naepels
P
P
Gondry
C
C
Besserve
P
P
Camier
B
B
Boulanger
J-C
JC
Gondry
J
J
D005260:Female; D005323:Fetal Monitoring; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011256:Pregnancy Outcome; D011269:Pregnancy, Abdominal / Q000175:diagnosis* / Q000628:therapy*; D012307:Risk Factors; D016216:Ultrasonography, Prenatal