Document Detail


Diagnosis and management of hepatic ectopic pregnancy.
MedLine Citation:
PMID:  17267889     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We present a case in which an adnexal mass caused symptoms that eventually lead to the identification of a primary hepatic pregnancy. CASE: A young woman presented with abdominal pain, a positive hCG test result, an empty uterus, and a pelvic mass. Diagnostic laparoscopy revealed a cystic adnexal mass. An exploratory laparotomy with ovarian cystectomy identified a mature teratoma but no evidence of pregnancy in the pelvis. Because the patient's quantitative hCG level continued to increase without evidence of an intrauterine pregnancy, a dilation and curettage was performed which yielded no products of conception. An ultrasound examination and magnetic resonance imaging identified an 11-week ectopic pregnancy with fetal cardiac activity located in the maternal liver. This was treated with fetal injections of methotrexate and potassium chloride under ultrasound guidance and subsequent maternal intramuscular injection of methotrexate. The patient tolerated these interventions well, and subsequent ultrasound examinations showed absent fetal cardiac activity and decreasing fetal size. Serial hCG tests were followed up to zero, and the patient's liver enzyme levels remained normal. CONCLUSION: With persistently rising hCG levels and no pregnancy identified in the uterus or pelvis, there should be a thorough evaluation of the entire pelvis and abdomen. Magnetic resonance imaging is a useful tool for locating such an ectopic pregnancy. Once identified, decisions regarding surgical versus medical management must take risk of adverse outcomes into consideration. This report reveals an 11-week hepatic pregnancy managed conservatively with fetal potassium chloride and maternal methotrexate administration.
Authors:
Stuart H Shippey; Snehal M Bhoola; Anthony B Royek; Mary E Long
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  109     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-01     Completed Date:  2007-02-20     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  544-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224-2780, USA. shshippey@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Abortifacient Agents, Nonsteroidal / administration & dosage
Adult
Diagnosis, Differential
Female
Humans
Injections
Laparoscopy
Liver*
Methotrexate / administration & dosage
Potassium Chloride / administration & dosage
Pregnancy
Pregnancy Trimester, First
Pregnancy, Ectopic / blood,  diagnosis*,  pathology,  radiography,  therapy*
Prenatal Diagnosis*
Chemical
Reg. No./Substance:
0/Abortifacient Agents, Nonsteroidal; 59-05-2/Methotrexate; 7447-40-7/Potassium Chloride

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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