///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

Anesthetic Management of a Suspected Abdominal Pregnancy

Abstract Number: 189
Abstract Type: Case Report/Case Series

Heather A Ballard MD1 ; Chau Nguyen MD2; Steve Pratt MD3

Introduction:

Abdominal pregnancy is a rare event that can lead to significant morbidity in the mother and fetus. There is limited discussion in the anesthesia literature of how to manage these patients. We present the multidisciplinary team management of a case of suspected abdominal pregnancy.

Case Review:

The patient was a 30yo G4P1 at 27 weeks gestation transferred to our hospital for suspicion of abdominal pregnancy. MRI confirmed the patients ectopic pregnancy, including possible gestation within a rudimentary vestigial uterine horn. A meeting was held with anesthesiology, obstetrics, neonatology, urology, nursing, and blood bank staff to plan for delivery. Decisions made during this meeting include: 1) scheduling delivery when all services could be present, 2) performing Cesarean section in main OR for better proximity to blood bank, 3) presence of several anesthesiologists, and two obstetric attending physicians, 4) performing Cesarean section under general anesthesia, 5) ureteral stent placement prior to delivery, 6) ability to activate massive transfusion protocol and eight units of red blood cells available prior to procedure, 7) NICU staff present at delivery, 8) general surgery physician available for emergency consult.

The patient was examined, consented, and a 16-gauge intravenous catheter placed. She was brought to the operating room, standard ASA monitors placed and general endotracheal anesthesia was induced via rapid sequence induction. Post induction, a radial arterial line and two large bore peripheral intravenous lines were placed. Ureteral stents were placed to prevent ureteral injury. Upon entering the abdomen, it was appreciated that the pregnancy was contained within a rudimentary uterine horn. The infant was delivered in breech position and presented to the NICU team. The uterine horn was resected with the placenta in situ. The estimated blood loss was 500mL. The patient was extubated at the end of the case and recovered in the PACU uneventfully. She was discharged home on postoperative day #4.

Discussion:

Abdominal pregnancy is rare, but associated with a high maternal mortality rate, (0.5-18%).1 Morbidity is due to massive hemorrhage, which can occur at any time during delivery. Leaving the placenta in situ after unanticipated abdominal pregnancy 2 and expeditious utilization of resources to adequately care for a hemorrhaging patient have been described to improve outcomes. 3 As better quality imaging becomes available, the diagnosis of abdominal pregnancy can be made prior to delivery. In this case, we present the management of a suspected abdominal pregnancy. We were able to develop a coordinated multidisciplinary care plan for this patient to quickly activate resources in case of massive hemorrhage.

References:

1. Martin JN Jr, et al. Obstet Gynecol 1988, 71:549-557

2. Amritha B, et al. J Med Case Reports. 2009 Jan 29;3:38.

3. Ramachandran K, Kirk P. Can J Anaesth. 2004 Jan;51(1):57-61.

SOAP 2010