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Primary hepatic pregnancy

Abdelazim, Ibrahim ; Shikanova, Svetlana ; Zhurabekova, Gulmira ; Starchenko, Tatyana

Journal of Emergencies, Trauma, and Shock, 2019-01-01, Vol.12 (1), p.68-69 [Peer Reviewed Journal]

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  • Title:
    Primary hepatic pregnancy
  • Author: Abdelazim, Ibrahim ; Shikanova, Svetlana ; Zhurabekova, Gulmira ; Starchenko, Tatyana
  • Subjects: Pregnancy ; Pregnant women ; Ultrasonic imaging ; Placenta ; Nuclear magnetic resonance--NMR ; Fetuses ; Abscesses ; Packaging ; Abdomen ; Letters to Editor
  • Is Part Of: Journal of Emergencies, Trauma, and Shock, 2019-01-01, Vol.12 (1), p.68-69
  • Description: Multidisciplinary team management includes senior obstetrician, anesthetist, surgeon, hepatologist, and radiologist, with blood bank and neonatal supports, which is crucial before termination of pregnancy (TOP) in such casesPreoperative magnetic resonance imaging (MRI) defines the regional anatomy and is crucial in identification of placental implantation; therefore, it can help in the decision of whether or not to remove the placenta during laparotomyPreoperative intragestational ultrasound-guided methotrexate (MTX) to destroy active trophoblastic tissue, to facilitates placental involution and decreases the bleeding risks, which has been reported in some cases of cesarean section scar pregnancies, interstitial ectopic pregnancies, and morbidly adherent placenta (MAP)[2],[3]The preoperative insertion of arterial catheters for intraoperative embolization if needed. The arterial embolization has been reported in cases of MAP successfully [4]Intraoperatively, the placenta should be kept in place without any attempt of removal unless was separated spontaneously, because any attempt to remove the placenta will precipitate uncontrollable massive bleeding [5]The intraoperative massive bleeding from the placenta site can be controlled by interlocking sutures and/or packing which removed 48 h or removal of the placenta with its attached structure, if this structure is removable and less vascular (omentum or adnexa)[5],[6]The packing or the placenta if left in situ associated with risks of ileus, peritonitis, and abscess formation necessitating a second laparotomy [6]Postoperatively, MTX systemic alternating with leucovorin (active folic acid) can be used to help placental involution. Conservative management of hepatic pregnancy could be feasible with follow-up using the newer imaging techniques (MRI and/or three-dimensional ultrasound) to localize the placenta accurately before TOP.
  • Publisher: India: Wolters Kluwer India Pvt. Ltd
  • Language: English
  • Identifier: ISSN: 0974-2700
    EISSN: 0974-519X
    DOI: 10.4103/JETS.JETS_151_18
    PMID: 31057289
  • Source: © ProQuest LLC All rights reserved

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