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- Title
Abdominal pregnancy resulting in a fully developed fetus: The importance of thorough microscopic examination.
- Authors
Loganathan, K.; Baker, P.; Stefanovici, C.
- Abstract
Introduction: Abdominal pregnancy is a rare variant of ectopic pregnancy accounting for 1.4% of all ectopic pregnancies (1 in 10,000 pregnancies). Due to its rarity and intricate anatomic changes, misdiagnosis on clinical and imaging studies may occur. Very few cases in the literature present the pathological findings of such an event. Clinical presentation: We report the case of a 29 years-old primigravida who presented initially with low-blood pressure and abdominal pain. She was diagnosed by imaging studies with a bicornuate uterus and followed closely. At 33 weeks, due to olygohydramnios, she was given steroids to minimize fetal prematurity-problems, and a C-section was performed. Intraoperatively a fully developed extrauterine fetus and abdominally implanted placenta were identified and extracted. A hysterectomy was required due to catastrophic hemorrhage. All tissue was submitted for pathological assessment. Results: Gross and microscopic examination of the sent tissue showed a circumferential thick layer of organized hemorrhage, interpreted on imaging as "bicornuate uterine wall". There was hemorrhagic infarction with migration and adherence, but not true implantation, of the placental villi to omentum, cul-de-sac, sigmoid colon, etc., demonstrated by the lack of intermediate trophoblast and vascular recruitment in those areas. The main implantation site however was the left adnexa, establishing the diagnosis of a ruptured tubal pregnancy with expulsion of a viable fetus and secondary development in the abdominal cavity. Conclusion: Pathological examination of the placental tissue clearly demonstrates that in an abdominal pregnancy, placenta can adhere superficially to other organs, but without true implantation resulting in a viable fetus.
- Subjects
ABDOMINAL pregnancy; FETAL development; MICROSCOPY; ABDOMINAL pain; CLINICAL trials
- Publication
Canadian Journal of Pathology, 2018, Vol 10, p35
- ISSN
1918-915X
- Publication type
Case Study