Embarazo ectópico abdominal: reporte de caso y revisión de la literatura

##plugins.themes.themeEleven.article.main##

Maritza García-Espinosa http://orcid.org/0000-0003-2565-2868
Abisaí Montaño-Martínez http://orcid.org/0000-0003-0555-0784
María de la Caridad Carranco-Salinas http://orcid.org/0000-0002-9490-454X
Germán Maytorena-Cordova http://orcid.org/0000-0002-5026-1802
Israel Bravo-Pérez http://orcid.org/0000-0002-2487-4488
Felipe Caldiño-Soto http://orcid.org/0000-0003-0061-4478

Keywords

Embarazo Ectópico, Embarazo Abdominal, Histerectomía / Pregnancy, Ectopic, Pregnancy, Abdominal, Hysterectomy

Resumen

Introducción: el embarazo ectópico abdominal es una complicación poco frecuente con elevada morbimortalidad materna y perinatal. El objetivo fue presentar el manejo multidisciplinario de un embarazo ectópico abdominal avanzado asociado a COVID-19 y hacer una revisión de la literatura.


Caso clínico: paciente multigesta de 33 años, con embarazo ectópico abdominal de 34 semanas, diagnosticado por ultrasonido a las 27 semanas. Seis días antes inició con dolor abdominal difuso. Fue referida con prueba RT-PCR para SARS-CoV-2 positiva, sin síntomas respiratorios. La tomografía reportó probable infiltración a asas intestinales, techo vesical y uretero derecho. El ultrasonido abdominal corroboró diagnóstico y mostró ausencia de compromiso de vasos iliacos y ureteros. La resonancia magnética reportó aporte vascular del lecho placentario dependiente de arteria iliaca derecha y ramos distales de mesentérica superior. Se hizo laparotomía exploradora y se encontró al feto vivo en cavidad abdominal con amnios roto, peso 2385 gramos, Apgar 5/8; placenta con implantación en ligamento ancho, salpinge, ovario, techo vesical, ligamento infundibulopélvico y apéndice. Se realizó histerectomía total abdominal con salpingooforectomía derecha, salpingectomía izquierda y apendicectomía. Hubo un sangrado total de 3000 mL y una evolución postquirúrgica favorable.


Conclusión: el embarazo ectópico abdominal representa un reto en la obstetricia. Ofrecer un manejo multidisciplinario permite tener un resultado favorable.

Abstract 63 | PDF Downloads 39

Referencias

Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10-year population-based study of 1800 cases. Hum Reprod. 2002;17(12):3224-30. doi:10.1093/humrep/17.12.3224.

Alkatout I, Honemeyer U, Strauss A, et al. Clinical diagnosis and treatment of ectopic pregnancy. Obstet Gynecol Surv. 2013;68(8):571-81. doi:10.1097/OGX.0b013e31829cdbeb.

Hossain MA, Begum F, Jahan S, et al. Embarazo a término de ligamento ancho con un recién nacido sano. Medicina. 2019;31(1):60-3. doi: 10.3329/medtoday.v31i1.40324.

Ramirez Cabrera J, Zapata Diaz B, Campos Siccha G, et al. Embarazo abdominal postérmino. Reporte de un caso. Rev Peru Ginecol y Obstet. 2019;65(2):209-12. doi: 10.31403/rpgo.v65i2176https://doi.org/10.24245/gom.v87i3.2493.

Poole A, Haas D, Magann EF. Early abdominal ectopic pregnancies: a systematic review of the literature. Gynecol Obstet Invest. 2012;74(4):249-60. doi: 10.1159/000342997.

Rabinerson D, Berezowsky A, Gabbay-Benziv R. Advanced abdominal pregnancy. Harefuah. 2017;156(2):114-7.

Nielsen SK, Møller C, Glavind-Kristensen M. Abdominal ektopisk graviditet. Ugeskr Laager. 2020;182(15):V08190467.

Lamina MA, Akinyemi BO, Fakoya TA,et al. Abdominal pregnancy: a cause of failed induction of labour. Niger J Med. 2005;14(2):213-7. doi: 10.4314/njm.v14i2.37183.

Chen L, Liu J, Shu J et al. Successful laparoscopic management of diaphragmatic pregnancy: a rare case report and brief review of literature. BMC Pregnancy Childbirth. 2019;19(1):99 doi: 10.1186/s12884-019-2248-0.

Hendriks E, Rosenberg R, Prine L. Ectopic Pregnancy: Diagnosis and Management. Am Fam Physician. 2020;101(10):599-606.

Ozen M, Birmingham E, Hoffman M et al. Non-surgical management of abdominal ectopic pregnancy with uterine artery embolization. Radiol Case Rep 2022;17(5):1631-3. doi: 10.1016/j.radcr.2022.02.040.

Deng MX, Zou Y. Evaluating a magnetic resonance imaging of the third-trimester abdominal pregnancy: What the radiologist needs to know. Medicine (Baltimore). 2017;96(48):e8986. doi: 10.1097/MD.0000000000008986.

Elmiski F, Ouafidi B, Elazzouzi E, et al. Abdominal pregnancy diagnosed by ultrasonography and treated successfully by laparotomy: Two cases report. Int J Surg Case Rep. 2021;83:105952 doi: 10.1016/j.ijscr.2021.105952.

Malian V, Lee JH. MR imaging and MR angiography of an abdominal pregnancy with placental infarction. AJR Am J Roentgenol. 2001;177(6):1305-6. doi: 10.2214/ajr.177.6.1771305.

Tromans PM, Coulson R, Lobb MO, et al. Abdominal pregnancy associated with extremely elevated serum alpha-fetoprotein. Case report. Br J Obstet Gynaecol. 1984;91(3):296-8. doi: 10.1111/j.1471-0528.1984.tb04773.x.

Escobar-Vidarte MF, Caicedo-Herrera G, Solarte-Erazo Juan D, et al. Embarazo ectópico abdominal avanzado: reporte de casos y revisión de la literatura. Rev Colomb Obstet Ginec. 2017;68 (1):71-82. doi: 10.18597/rcog.2983.

Harirah HM, Smith JM, Dixon CL, et al. Conservative Management and Planned Surgery for Periviable Advanced Extrauterine Abdominal Pregnancy with Favorable Outcome: Report of Two Cases. AJP Rep. 2016;6(3):e301-8. doi: 10.1055/s-0036-1588003.

Udigwe GO, Eleje GU, Ihekwoaba EC, et al. Acute Intestinal Obstruction Complicating Abdominal Pregnancy: Conservative Management and Successful Outcome. Case Rep Obstet Gynecol. 2016;2016:2576280 doi: 10.1155/2016/2576280.

Nassali MN, Benti TM, Bandani-Ntsabele M, et al. A case report of an asymptomatic late term abdominal pregnancy with a live birth at 41 weeks of gestation. BMC Res Notes. 2016;9:31. doi: 10.1186/s13104-016-1844-6.

El-Agwany AS, El-Badawy el-S, El-Habashy A, et al. Secondary Advanced Abdominal Pregnancy after Suspected Ruptured Cornual Pregnancy with Good Maternal Outcome: A Case with Unusual Gangrenous Fetal Toes and Ultrasound Diagnoses Managed by Hysterectomy. Clin Med Insights Womens Health. 2016;9:1-5. doi: 10.4137/CMWH.S36311.

Bhoil R, Aggarwal N, Jhobta A, et al. Advanced abdominal pregnancy with successful outcome. Intern Emerg Med. 2016;11(6):877-8. doi: 10.1007/s11739-015-1339-9.

Brouard KJ, Howard BR, Dyer RA. Hepatic Pregnancy Suspected at Term and Successful Delivery of a Live Neonate With Placental Attachment to the Right Lobe of the Liver. Obstet Gynecol. 2015;126(1):207-10. doi: 10.1097/AOG.0000000000000703.

Mengistu Z, Getachew A, Adefris M. Term abdominal pregnancy: a case report. J Med Case Rep. 2015;9:168. doi: 10.1186/s13256-015-0635-3.

Gidiri MF, Kanyenze M. Advanced abdominal ectopic pregnancy: lessons from three cases from Zimbabwe and a literature appraisal of diagnostic and management challenges. Womens Health. 2015;11(3):275-9. doi: 10.2217/whe.15.3.

Dabiri T, Marroquin GA, Bendek B, et al. Advanced extrauterine pregnancy at 33 weeks with a healthy newborn. Biomed Res Int. 2014;2014:102479. doi: 10.1155/2014/102479.

Marcellin L, Ménard S, Lamau MC, et al. Conservative management of an advanced abdominal pregnancy at 22 weeks. AJP Rep. 2014;4(1):55-60. doi:10.1055/s-0034-1371749.

Joshi B, Aggarwal N, Singh A. Obstetrical catastrophe averted: successful outcome of an abdominal pregnancy. Am J Emerg Med. 2014;32(10). doi: 10.1016/j.ajem.2014.03.041.

Matovelo D, Ng'walida N. Hemoperitoneum in advanced abdominal pregnancy with a live baby: a case report. BMC Res Notes. 2014;7:106. doi: 10.1186/1756-0500-7-106.

Renfroe S, Dajani NK, Pandey T, et al. Role of serial MRI assessment in the management of an abdominal pregnancy. BMJ Case Rep. 2013;2013:bcr2013200495. doi: 10.1136/bcr-2013-200495.

Smrtka MP, Gunatilake R, Miller MJ, et al. Improving the management of an advanced extrauterine pregnancy using pelvic arteriography in a hybrid operating suite. AJP Rep. 2012;2(1):63-6. doi: 10.1055/s-0032-1322507.

Aliyu LD, Ashimi AO. A multicentre study of advanced abdominal pregnancy: a review of six cases in low resource settings. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):33-8. doi: 10.1016/j.ejogrb.2013.05.022.

Masukume G, Sengurayi E, Muchara A, et al. Full-term abdominal extrauterine pregnancy complicated by post-operative ascites with successful outcome: a case report. J Med Case Rep. 2013;7:10. doi: 10.1186/1752-1947-7-10.

Kim MJ, Bae JY, Seong WJ, et al. Sonographic diagnosis of a viable abdominal pregnancy with planned delivery after fetal lung maturation. J Clin Ultrasound. 2013;41(9):563-5. doi: 10.1002/jcu.22010.

Collins SL, Grant D, Black RS, et al. Abdominal pregnancy: a perfusion confusion? Placenta. 2011;32(10):793-5. doi: 10.1016/j.placenta.2011.07.032.

Dahab AA, Aburass R, Shawkat W, et al. Full-term extrauterine abdominal pregnancy: a case report. J Med Case Rep. 2011;5:531. doi: 10.1186/1752-1947-5-531.

Baffoe P, Fofie C, Gandau BN. Term abdominal pregnancy with healthy newborn: a case report. Ghana Med J. 2011;45(2):81-3. doi: 10.4314/gmj.v45i2.68933.

Brewster EM Sr, Braithwaite EA, Brewster EM Jr. Advanced abdominal pregnancy: a case report of good maternal and perinatal outcome. West Indian Med J. 2011;60(5):587-9.

Ramphal SR, Moodley J, Rajaruthnam D. Hepatic pregnancy managed conservatively. Trop Doct. 2010;40(2):121-2. doi: 10.1258/td.2009.090218.

Gupta P, Sehgal A, Huria A, et al. Secondary abdominal pregnancy and its associated diagnostic and operative dilemma: three case reports. J Med Case Rep. 2009;3:7382. doi: 10.4076/1752-1947-3-7382.

Oneko O, Petru E, Masenga G, et al. Management of the placenta in advanced abdominal pregnancies at an East African tertiary referral center. J Womens Health 2010;19(7):1369-75. doi: 10.1089/jwh.2009.1704.

Sunday-Adeoye I, Twomey D, Egwuatu EV, et al. A 30-year review of advanced abdominal pregnancy at the Mater Misericordiae Hospital, Afikpo, southeastern Nigeria (1976-2006). Arch Gynecol Obstet. 2011;283(1):19-24. doi: 10.1007/s00404-009-1260-4.

Worley KC, Hnat MD, Cunningham FG. Advanced extrauterine pregnancy: diagnostic and therapeutic challenges. Am J Obstet Gynecol. 2008;198(3):297.e1-7. doi: 10.1016/j.ajog.2007.09.044.

Isah AY, Ahmed Y, Nwobodo EI, et al. Abdominal pregnancy with a full term live fetus: case report. Ann Afr Med. 2008;7(4):198-9. doi: 10.4103/1596-3519.55653.

Promsonthi P, Herabutya Y. Uterocutaneous fistula in term abdominal pregnancy. Eur J Obstet Gynecol Reprod Biol. 2007;132(2):239-41. doi: 10.1016/j.ejogrb.2006.04.041.

Lockhat F, Corr P, Ramphal S, et al. The value of magnetic resonance imaging in the diagnosis and management of extra-uterine abdominal pregnancy. Clin Radiol. 2006;61(3):264-9. doi: 10.1016/j.crad.2005.10.013.

Roberts RV, Dickinson JE, Leung Y, et al. Advanced abdominal pregnancy: still an occurrence in modern medicine. Aust N Z J Obstet Gynaecol. 2005;45(6):518-21. doi: 10.1111/j.1479-828X.2005.00489.x.

Tshivhula F, Hall DR. Expectant management of an advanced abdominal pregnancy. J Obstet Gynaecol. 2005;25(3):298. doi: 10.1080/ 0144361050010 6819.

Godyn JJ, Hazra A, Gulli VM. Subperitoneal placenta accreta succenturiate in the case of a successful near-term extrauterine abdominal pregnancy. Hum Pathol. 2005;36(8):922-6. doi: 10.1016/j.humpath.2005.05.020.

Xiao GH, Chen DJ, Sun XF, et al. Abdominal pregnancy: full-term viable baby. Eur J Obstet Gynecol Reprod Biol. 2005;118(1):117-8. doi: 10.1016/j.ejogrb.2004.04.027.

Raughley MJ, Frishman GN. Local treatment of ectopic pregnancy. Semin Reprod Med. 2007;25(2):99-115. doi: 10.1055/s-2007-970049.

Okorie CO. Retroperitoneal ectopic pregnancy: is there any place for non-surgical treatment with methotrexate? J Obstet Gynaecol Res. 2010;36(5):1133-6. doi: 10.1111/j.1447-0756.2010.01270.x.

Shaw SW, Hsu JJ, Chueh HY, et al. Management of primary abdominal pregnancy: twelve years of experience in a medical centre. Acta Obstet Gynecol Scand. 2007;86(9):1058-62. doi: 10.1080/00016340701434476.

Varma R, Mascarenhas L, James D. Successful outcome of advanced abdominal pregnancy with exclusive omental insertion. Ultrasound Obstet Gynecol. 2003;21(2):192-4. doi: 10.1002/uog.25.

Rahaman J, Berkowitz R, Mitty H, et al. Minimally invasive management of an advanced abdominal pregnancy. Obstet Gynecol. 2004;103(5 Pt 2):1064-8. doi: 10.1097/01.AOG.0000127946.14387.48.

Hymel JA, Hughes DS, Gehlot A, et al. Late Abdominal Pregnancies (≥20 Weeks Gestation): A Review from 1965 to 2012. Gynecol Obstet Invest. 2015;80(4):253-8. doi: 10.1159/000381264.

Ayinde OA, Aimakhu CO, Adeyanju OA, et al. Abdominal pregnancy at the University College Hospital, Ibadan: a ten-year review. Afr J Reprod Health. 2005;9(1):123-7.