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Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report

BACKGROUND: Abdominal pregnancies are a rare occurrence and are associated with high maternal and perinatal mortality rates compared to intra-uterine and other ectopic pregnancies. Localization of sites of abdominal pregnancies and determining the gestational age at the time of diagnosis play a fund...

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Autores principales: Mushema, Beata Nyangoma, Nkwama, Beno Steven, Rweyemamu, George Alcard, Makanda, Isaac Hamis, Chiduo, Monica
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The East African Health Research Commission 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624215/
https://www.ncbi.nlm.nih.gov/pubmed/37928869
http://dx.doi.org/10.24248/eahrj.v6i1.673
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author Mushema, Beata Nyangoma
Nkwama, Beno Steven
Rweyemamu, George Alcard
Makanda, Isaac Hamis
Chiduo, Monica
author_facet Mushema, Beata Nyangoma
Nkwama, Beno Steven
Rweyemamu, George Alcard
Makanda, Isaac Hamis
Chiduo, Monica
author_sort Mushema, Beata Nyangoma
collection PubMed
description BACKGROUND: Abdominal pregnancies are a rare occurrence and are associated with high maternal and perinatal mortality rates compared to intra-uterine and other ectopic pregnancies. Localization of sites of abdominal pregnancies and determining the gestational age at the time of diagnosis play a fundamental role in guiding the treatment approach and minimizing potential complications. However, the vague presentation coupled with low accuracy of ultrasound detection often leads to misdiagnosis of abdominal pregnancy, and hence delaying initiation of appropriate management. We present a case of a second trimester abdominal pregnancy detected following failure of induction for an initial diagnosis of missed abortion, and the ensuing outcome, rarely reported in limited-resource settings. CASE PRESENTATION: A 19 year old unbooked woman, gravida 2 para 1 at 17(th) week gestation age by ultrasound presented with loss of foetal movement for one week. Based on clinical assessment and referral ultrasound findings, she was initially diagnosed with missed abortion and planned for induction. Failure of induction prompted a repeat ultrasound which revealed a non-viable abdominal pregnancy. Laparotomy was done, localisation of the pregnancy at the omentum was observed and a dead foetus was extracted with the placenta left in-situ. A complication of surgical wound dehiscence with infection developed post-operatively and was managed with secondary sutures. The patient recovered and was discharged in a stable condition. CONCLUSION: This case demonstrates that the diagnosis of abdominal pregnancy remains a challenge especially in settings where skilled human resources for health are few and equipment and supplies for effective and timely treatment are limited. The case sheds some light on the broader challenges in maternal and perinatal health in developing countries. Accurate pre-operative diagnosis requires a high index of suspicion, especially due to the variability of its presentation. This case emphasises the important of quality antenatal care and the need for clinicians to conduct comprehensive assessments of patients and receive training on obstetric ultrasound skills.
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spelling pubmed-106242152023-11-04 Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report Mushema, Beata Nyangoma Nkwama, Beno Steven Rweyemamu, George Alcard Makanda, Isaac Hamis Chiduo, Monica East Afr Health Res J Case Study BACKGROUND: Abdominal pregnancies are a rare occurrence and are associated with high maternal and perinatal mortality rates compared to intra-uterine and other ectopic pregnancies. Localization of sites of abdominal pregnancies and determining the gestational age at the time of diagnosis play a fundamental role in guiding the treatment approach and minimizing potential complications. However, the vague presentation coupled with low accuracy of ultrasound detection often leads to misdiagnosis of abdominal pregnancy, and hence delaying initiation of appropriate management. We present a case of a second trimester abdominal pregnancy detected following failure of induction for an initial diagnosis of missed abortion, and the ensuing outcome, rarely reported in limited-resource settings. CASE PRESENTATION: A 19 year old unbooked woman, gravida 2 para 1 at 17(th) week gestation age by ultrasound presented with loss of foetal movement for one week. Based on clinical assessment and referral ultrasound findings, she was initially diagnosed with missed abortion and planned for induction. Failure of induction prompted a repeat ultrasound which revealed a non-viable abdominal pregnancy. Laparotomy was done, localisation of the pregnancy at the omentum was observed and a dead foetus was extracted with the placenta left in-situ. A complication of surgical wound dehiscence with infection developed post-operatively and was managed with secondary sutures. The patient recovered and was discharged in a stable condition. CONCLUSION: This case demonstrates that the diagnosis of abdominal pregnancy remains a challenge especially in settings where skilled human resources for health are few and equipment and supplies for effective and timely treatment are limited. The case sheds some light on the broader challenges in maternal and perinatal health in developing countries. Accurate pre-operative diagnosis requires a high index of suspicion, especially due to the variability of its presentation. This case emphasises the important of quality antenatal care and the need for clinicians to conduct comprehensive assessments of patients and receive training on obstetric ultrasound skills. The East African Health Research Commission 2022 2022-07 /pmc/articles/PMC10624215/ /pubmed/37928869 http://dx.doi.org/10.24248/eahrj.v6i1.673 Text en © The East African Health Research Commission 2022 https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Case Study
Mushema, Beata Nyangoma
Nkwama, Beno Steven
Rweyemamu, George Alcard
Makanda, Isaac Hamis
Chiduo, Monica
Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report
title Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report
title_full Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report
title_fullStr Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report
title_full_unstemmed Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report
title_short Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report
title_sort challenges in diagnosis and management of second trimester omental pregnancy in limited resource settings: case report
topic Case Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624215/
https://www.ncbi.nlm.nih.gov/pubmed/37928869
http://dx.doi.org/10.24248/eahrj.v6i1.673
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