Rare pregnancy case at Sando hospital

Doctors at the San Fernando General Hospital yesterday successfully terminated a very rare and complicated abdominal pregnancy at 24 weeks gestation to save the life of the mother.Only one other such case, which occurs in one in every 100,000 pregnancies, is recorded in recent history at the hospital.The three-hour surgery was performed by a highly specialised team, headed by consultant obstetrics gynaecologist Dr Krishna Rampersadsingh, who had successfully treated another abdominal pregnancy in 2006.The team also included specialists Dr Dilip Dan and Dr Michael Persad, senior house officer Dr Sahazard Soobratee, urologist Dr Kishan Ramsoobhag, paediatrician Dr Inga Roberts, anaesthetist Dr Brian Foon and a host of nurses.

The mother of four, whose identity is being kept secret, asked for the pregnancy to be terminated because her life was at risk.She was placed in the hospitals Intensive Care Unit (ICU) as a precautionary measure following the surgery. Dr Rampersadsingh was confident the operation was a success.Chairman of the board of the South West Regional Health Authority (SWRHA) Dr Lackram Bodoe confirmed the three-hour operation had taken place.He told the T&T Guardian that was the second case at the SFGH and was good news for the hospital, especially against the background of the death of Chrystal Boodoo-Ramsoomair, following the birth of her child in March.

Rampersadsingh explained that an abdominal pregnancy is extreme. Dr Bodoe said such pregnancies pose extreme danger to the mother because the placenta is outside of the uterus and there is a high risk of haemorrhaging and death during delivery.Rampersadsingh said the mother, who is from Ste Madeleine, was referred to him by her personal gynaecologist five weeks ago.He said two weeks ago, the expectant mother, who had to be on complete bed rest, except for bathroom privileges, found the situation too stressful to advance further.After consultation with her family and research of her situation, she asked for the termination.

How it occurs

Abdominal pregnancies occur when the fertilised egg implants outside of the womb in the woman’s abdomen. Abdominal pregnancies require a surgery to remove the pregnancy as the majority of these pregnancies are not viable.The first type of abdominal pregnancy can occur when a fallopian tube that holds the pregnancy ruptures when the embryo becomes too large, resulting in a the embryo implanting in the abdominal cavity.This can be dangerous to the expectant mother because often the pregnancy can appear as a normal pregnancy until the seventh or eighth week when the tube ruptures.

This can cause blood loss, and if not properly treated can result in death of the mother. The location of implantation after the rupture can cause fetal demise as well as the death of the mother if both survive the ruptured tube.In an extrauterine/intra-abdominal pregnancy, the egg leaves the ovary but does not enter the fallopian tube and is fertilised and implanted in the abdominal cavity.The fertilised egg implants outside of the uterus, usually in an area that has a healthy blood supply like near a major artery.This is a rare occurrence but the result is usually the same as a ruptured fallopian tube pregnancy as the implantation near an artery can cause fetal demise and death of the mother if it is not detected early.

Excerpt from:
Rare pregnancy case at Sando hospital


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