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Volume 8 Gynecology & Obstetrics Gynecology Congress 2018
August 22-23, 2018
August 22-23, 2018 Tokyo, Japan
5 th Asia Pacific
Gynecology and Obstetrics Congress
Parul Nigam, Gynecol Obstet 2018, Volume 8
DOI: 10.4172/2161-0932-C3-030
Primary abdominal pregnancy with incisional hernia with previous two caesarean sections
Parul Nigam
St. Jude’s Hospital Jhansi, India
Primary abdominal pregnancy is an extremely rare type of extra uterine pregnancy. It is potentially life threatening form of
ectopic gestation with incidence of 1% of all ectopic pregnancies. Most of these pregnancies are terminated earlier due to
spontaneous separation from the site of implantation and the patient may present with shock. So, a high index of suspicion is
important for making a correct diagnosis especially with GI symptoms and its timely management. We report a case of primary
abdominal pregnancy with incisional hernia in 35 years old Gravida 3 para 2 with previous 2 caesarean sections. She presented
to us with severe abdominal distension and shock on account of herniation and obstruction of small bowel. She had severe
nausea, vomiting and abdominal discomfort. She had not passed stools since last 2 days. She had been admitted earlier in a
private nursing home for bleeding per vaginum. Dilatation and curettage was done without any antenatal ultrasound. Urine
pregnancy test was positive. But her condition deteriorated after few hours and she was referred to a higher centre. Ultrasound
was done which showed grossly dilated bowel loops and 15 weeks size fetus in the abdominal cavity. Emergency laparotomy
was done obstructive incisional hernia was found due to previous caesarean section scar. Small bowel was entangled in the
hernia sac. A live fetus of about 15 weeks was found trapped between the bowel loops. Placenta was attached to the omentum of
the small bowel. Uterus was enlarged- about 10 weeks in size. Bilateral tubes and ovaries were normal. Contents of the hernial
sac were reduced. Primary repair of hernia was done. Fetus was removed from the implantation site. There was no bleeding
from the site. Patient was transfused two units of blood. Her post-operative period was uneventful and she was discharged
satisfactorily on day 7. Hence, ultrasound should always be done to rule out ectopic before termination of pregnancy. Midline
vertical incisions are associated with increased incidence of ventral hernia. Complications of hernia like strangulation and
ulceration of skin are to be avoided and managed during pregnancy.
Biography
Parul Nigam is a well-known reputed Gynecologist in Jhansi, India with a Post Graduate degree in Obstetrics and Gynecology from world famous King George
Medical University Lucknow, India. She has 10 years of experience in the field. She has formal Subspecialty training in Gynecological Endoscopy, Diploma in
Gynecology Ultrasound and 1 year certificate course in diabetes. She is currently doing research work in the field of infertility and fetal medicine. Her specialization
is in the field of complete women health care solution. She is presently working as a Consultant in Nigam Hospital and St. Jude’s Hospital Jhansi.