Abdominal Pregnancy Treatment
Treatment:
Deal with intra-abdominal pregnancy are more complicated because of the accumulation of experience and improvements in surgical techniques, Stevens et al (1993) report in the past 20 years, maternal mortality has been from 20% to 5%.
Abdominal Pregnancy with the existence of pregnancy can happen infections, abscesses and sinus, so the diagnosis is established that one should consider the surgical treatment of the placenta are the key to the deal, such as improper handling can happen noodle attachment of the placenta substantial bleeding and organ injury. Therefore, surgery should be in accordance with its placental attachment site, whether the fetus had died and death The length of time to determine the treatment method
Not removed at surgery such as intra-abdominal fetus, it may happen the following cases: ① residual fetal bone, soft tissue absorption; ② formed adipocere; ③ fetal stone formation or calcification; ④ fetal tissue infections, necrosis, abscess formation; ⑤ If the fetus Organize long-term stay in the abdominal cavity could be penetrated through the bladder, rectal discharge, such as the formation of abdominal fistula.
Authors have advocated the use of methotrexate residual damage to the placenta. Its mechanism are methotrexate can be destructive to trophoblast organizations to reduce the placental blood supply leading to the degeneration and necrosis can be reduced to normal levels of HCG use are disadvantage damaged placental tissue stay in the intra-abdominal bacterial medium are good, there is concurrent infections, peritonitis caused by abdominal wound dehiscence, pelvic abscess, septicemia, etc. may be serious or even fatal. No cases of methotrexate, although the placenta to absorb slower, but delayed recovery in patients with fewer complications.
1. Preoperative blood must be prepared, ready to do a good job of intestinal
2. Such as fetal survival or death soon after removed the fetus, the placenta at the umbilical cord attached noodle Department ligation to cut off the umbilical cord, placenta retention, therefore, when intra-abdominal placenta noodle plant organ or tissue and abdominal cavity adhesions close sinusoids rich lien stripping can be bleeding of the placenta there is probably not the absorption of the absorption machine, after considering surgery treatment program
3. Such as fetal death has long been full weeks or months more, small plant placenta, the placenta has been shrinking, many have been closed sinusoid can be stripped out the entire trial in general not much bleeding.
4. Placental plant up in the greater omentum, the greater omentum can be removed but in the plant such as pelvic within must not forcibly dug up, its difficult to control bleeding. Some scholars of the placenta to the plant floor who first percutaneous femoral artery line to do pelvic angiography after embolization of internal iliac artery, and then resorted to surgery significantly reduced blood volume. If intraoperative bleeding can also happen this method to stop bleeding.
In recent years, surgery had led to retention of placental infection, abscess wound is not healed, and reports of intestinal obstruction, hydronephrosis mother still happen, and even pre-eclampsia happened persistent placenta removed until 99 days after the reports of healing. However, in contrast to the operation of dangerous bleeding, the majority of scholars still have the placenta retention deal with the views of the future. Such as retention of placenta in intra-abdominal, the serum β-HCG can observe the decline, the majority of the rapid decline, but Belfar et al (1986) Report of the placenta has time to absorb up to 5 years.