Obstet Gynecol Sci.  2018 Jan;61(1):154-160. 10.5468/ogs.2018.61.1.154.

A secondary abdominal pregnancy with unusual placental implantation in the fallopian tube: a diagnostic challenge

• Paola A
• Elena N
• Maria RS
• Orlando C
• Cinzia M
• Antonella

• KMID: 2420165
• DOI: http://doi.org/10.5468/ogs.2018.61.1.154

Abstract

We reported a case of secondary abdominal pregnancy with placental implantation into the fallopian tube, diagnosed at 16 weeks, in a woman admitted to the emergency room complaining of syncopal attacks. The best approach would be termination of the pregnancy, taking into consideration the high risk to the mother and the low possibility of alive and healthy birth. We had to perform an urgent surgical intervention due to the fact that the patient was in a clinically unstable condition, which was related to hemoperitoneum. If placental implantation is on abdominal organs or vessel the best approach would be to ligate the cord and to leave placenta in situ. Taking into consideration the place of placental implant, the removal of the fallopian tube with the placenta was the safest approach in this case. The best and most acceptable form of treatment would be individualized in case of rare form of ectopic pregnancy.

Keyword

Abdominal pregnancy; Placenta; Ultrasonography; Laparotomy

MeSH Terms

Emergency Service, Hospital
Fallopian Tubes*
Female
Hemoperitoneum
Humans
Laparotomy
Mothers
Parturition
Placenta
Pregnancy
Pregnancy, Abdominal*
Pregnancy, Ectopic
Ultrasonography

Figure

• 

  Fig. 1 Ultrasound finding at the fist evaluation at emergency room. (A) the anti-verted empty uterus; (B) a rounded image with hyperechoic boundaries, suggestive of fetal head in the upper right side of abdomen; (C) a normal right ovary of 32×13 mm; (D) a left adnexa with a hyperechoic mass of 68×56 mm, with not univocal interpretation.

• 

  Fig. 2 Fetal connection to left fallopian tube, site of placental implantation.

• 

  Fig. 3 Macroscopic cut to the suspected site of placental implantation, to confirm placenta presence.

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