Abdominal pregnancy resulting in a liveborn infant is an obstetric rarity in Denmark. A case is reported and four cases reported during the past 20 years are reviewed. In the present case, the diagnosis of extrauterine pregnancy was not established in advance. The infant, a full-term boy weighing 3,650 g, was delivered transplacentally by Caesarean section during epidural analgesia. The placenta was adherent to the intestines and was left in the abdomen for spontaneous resorption but was expelled gradually through an amnio-percutaneous fistula over a period of three months. The infant did not present any evidence of congenital abnormalities.
This work is motivated by a longitudinal study of women and their ectopic pregnancy outcomes in Lund, Sweden. In this article, we review and apply the Liang-Zeger methodology to the Lund ectopic pregnancy data set. We further analyse the ectopic pregnancy data using conditional modelling approaches suggested by Rosner and Bonney. From the Lund ectopic pregnancy data, we learned that PID is the strongest predictor of subsequent development of ectopic pregnancy and that there is a monotone relationship between PID severity and ectopic pregnancy. We also learned that the presence of mycoplasma from lower or upper genital tract sites at index laparoscopy is also a strong predictor of ectopic pregnancy. Other correlates of ectopic pregnancy include age at pregnancy and history of gynaecologic surgery.
There were 132 maternal deaths in British Columbia in the years 1963 to 1970. The mean maternal mortality rate for these eight years was 0.317. Sixty of these deaths (45.5%) were due to direct obstetrical causes. Indirect and nonrelated deaths accounted for 21.2 and 33.3% of the total, respectively. The most common causes of direct obstetrical deaths were hemorrhage, infection and vascular accidents, in that order; pre-eclampsia ranked a distant fourth. Ninety-five percent of direct obstetrical deaths were probably avoidable. Approximately 27% of all direct obstetrical deaths were abortion-related. Hemorrhage continues to be a major problem, in particular among the native Indian women of the province.If further reduction in maternal mortality is to be achieved, obstetrical hemorrhage must be better managed and deaths due to abortions reduced. Future studies should reveal if the liberalized abortion laws will assist in the realization of the latter goal.
Cites: Can Med Assoc J. 1965 Jan 23;92:160-7014232190
During the period 1969 to 1985, 640 women with a confirmed diagnosis of ectopic pregnancy were admitted to Sentralsykehuset i Akershus. The case histories were reviewed for possible predisposing factors. From 1969 to 1985 the frequency of ectopic pregnancy increased threefold in relation to the number of conceptions in the same region. Until 1978 the major part of this increase was observed among women with IUCD in situ. Women who had previously undergone surgery on the uterine tubes accounted for the greater part of the increase in extrauterine pregnancies after 1976. A large year-to-year variation was found among women with neither of the above predisposing factors. However, a rising frequency of ectopic pregnancies was also observed in this group. It appears that the risk of ectopic pregnancy is greater among women using IUCD than among women using other methods of contraception.