Minimally invasive management of an advanced abdominal pregnancy.
BACKGROUND
Advanced abdominal pregnancy is a rare, life-threatening condition that presents a number of challenges.


METHODS
A 29-year-old primigravida with 10 years of secondary infertility and a previous tuboplasty had a 21-week abdominal pregnancy treated with preoperative arterial embolization before laparoscopically assisted fetal delivery. Postoperatively, 4 cycles of methotrexate were administered at 50 mg/m2 intramuscularly every 3 weeks for the retained abdominal placenta. Subsequent spontaneous conception occurred, and a live, full-term infant was delivered by cesarean delivery 17 months later. No adverse sequelae were found during long-term follow-up.


CONCLUSIONS
This report demonstrates successful minimally invasive management of an advanced abdominal pregnancy with a multimodal approach that included preoperative arterial embolization, laparoscopically assisted delivery, and judicious use of postoperative methotrexate.
Rahaman
Jamal
J
Department of Obstetrics, Gynecology, and Reproductive Sciences, Mount Sinai Medical Center, New York, New York 10029, USA. jamal.rahaman@mssm.edu
Berkowitz
Richard
R
Mitty
Harold
H
Gaddipati
Sreedhar
S
Brown
Barry
B
Nezhat
Farr
F
D000328:Adult; D002585:Cesarean Section; D003131:Combined Modality Therapy; D036861:Delivery, Obstetric / Q000379:methods; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000008:administration & dosage; D018457:Placenta, Retained / Q000628:therapy; D011182:Postoperative Care; D011247:Pregnancy; D011269:Pregnancy, Abdominal / Q000175:diagnosis / Q000628:therapy*
D008727:Methotrexate