ABRUPTION OF ABDOMINAL PREGNANCY FOLLOWING BLUNT TRAUMA

Objectives:

Background: Abdominal pregnancy represents a rare subset of ectopic pregnancy with a reported incidence around one per 10,000 live births. It is associated with high fetal and maternal morbidity and mortality. Abdominal pregnancy remains difficult to diagnose and often presents as abdominal hemorrhage.

Methods: In this case, we describe a 25-year-old primigravida female who presented as a trauma activation with acute hypotension following blunt trauma to the abdomen and who was found to have a viable abdominal pregnancy with placental abruption.

Results: A 25-year-old primigravida female presented via ambulance as a trauma activation for hypotension following blunt trauma to the abdomen. FAST exam was inconclusive and fetal heart rate was 76 beats/minute. Given the patient’s hypotension and the non-reassuring fetal heart tones, the decision was made to take the patient to the operating room for emergent exploratory laparotomy and cesarean section. In the operating room, the uterus did not appear gravid and a large gestational sac and placenta were noted within the abdomen posterior to the uterus. Amniotomy was performed and a 0.78-kilogram male fetus was delivered. The placenta was severely adhered to a portion of small bowel, the appendix, and the right adnexa with an approximate 20% abruption. The placenta and adhered structures were removed. Given ongoing hemodynamic instability, laparotomy pads were placed behind the uterus and the patient was left in discontinuity. Negative pressure temporary abdominal closure was placed with plans to return to the operating room for subsequent re-exploration, establishment of continuity, and abdominal closure. She remained intubated and was transferred to the ICU in guarded condition. She returned to the operating room the following day for re-exploration. General surgery and obstetrician-gynecology physicians were both present. The abdomen was inspected and it was felt to be hemostatic and without retained placental tissue. A hand sewn, side-to-side small bowel anastomosis was created approximately 20 cm from the cecum. The abdomen was then washed out and subsequently closed. The patient recovered uneventfully and she was discharged on day six of admission.

Conclusion: Abdominal pregnancy is a rare obstetric complication. In pregnant patients presenting after blunt trauma with free intra-abdominal fluid and hypotension, abdominal pregnancy with abruption should be considered as an unlikely differential.

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