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Obstetrics & Gynecology 2004;103:1064-1068
© 2004 by The American College of Obstetricians and Gynecologists
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CASE REPORTS

Minimally Invasive Management of an Advanced Abdominal Pregnancy

Jamal Rahaman, MD, Richard Berkowitz, MD, Harold Mitty, MD, Sreedhar Gaddipati, MD, Barry Brown, MD and Farr Nezhat, MD

Departments of Obstetrics, Gynecology and Reproductive Sciences, and Radiology, Mount Sinai Medical Center, New York, New York

Address reprint requests to: Jamal Rahaman, MD, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Mount Sinai Medical Center, 1176 Fifth Avenue, Box 1173, New York, NY 10029; e-mail: jamal.rahaman{at}mssm.edu.

BACKGROUND: Advanced abdominal pregnancy is a rare, life-threatening condition that presents a number of challenges.

CASE: A 29-year-old primigravida with 10 years of secondary infertility and a previous tuboplasty had a 21-week abdominal pregnancy treated with preoperative arterial embolization before laparoscopically assisted fetal delivery. Postoperatively, 4 cycles of methotrexate were administered at 50 mg/m2 intramuscularly every 3 weeks for the retained abdominal placenta. Subsequent spontaneous conception occurred, and a live, full-term infant was delivered by cesarean delivery 17 months later. No adverse sequelae were found during long-term follow-up.

CONCLUSION: This report demonstrates successful minimally invasive management of an advanced abdominal pregnancy with a multimodal approach that included preoperative arterial embolization, laparoscopically assisted delivery, and judicious use of postoperative methotrexate.




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