In a medical scenario that seems more aligned with the plot of a dramatic television show than reality, a case of advanced hepatic pregnancy—a rare form of ectopic pregnancy where the embryo implants in the liver—has reached term, resulting in the remarkable birth of a live neonate. Hepatic pregnancy itself is an exceptionally rare event, with only 21 cases reported in English medical literature over six decades, and only 29% of those progressing beyond the first trimester. The successful delivery of a live neonate from such a pregnancy is a testament to the extraordinary capabilities of modern medicine and the resilience of the human body.
The diagnosis of this hepatic pregnancy was confirmed during a laparotomy, revealing an anomaly so remarkable that it defies the typical medical narrative for ectopic pregnancies. The gravity of the situation is underscored by the words of a maternal-fetal medicine specialist, David Hackney, MD, who admitted to never having seen such a case in his career, calling it “the rarest of the rare.” An advanced abdominal ectopic pregnancy carries with it a maternal mortality rate more than 7 times higher than other ectopic pregnancies due to the risk of massive placental hemorrhage, as highlighted by the French researchers Gorincour and Boukerrou.”An abdominal pregnancy is the only type of ectopic pregnancy that can go beyond 20 weeks gestation,” Gorincour said, noting that implantation sites can include “the peritoneum of the pelvic and abdominal cavity, or even abdominal organs such as the spleen, intestine, liver and blood vessels.”
The patient, a 37-year-old woman with a history of two vaginal deliveries and one miscarriage, unexpectedly became a statistical outlier when she presented with abdominal pain. Subsequent ultrasonography and an MRI painted a picture of a thickened endometrium and an empty uterus—hallmarks of an abdominal pregnancy. Remarkably, at 23 weeks’ gestation, a normally formed intra-abdominal fetus was identified, with a placenta that had attached to an unconventional site, “above the sacral promontory.” The discovery marked a critical point in the patient’s journey, necessitating a transfer to a tertiary care hospital for specialized care.
As the pregnancy progressed to 29 weeks, the medical team meticulously orchestrated a laparotomy to deliver the infant, carefully navigating the myriad risks. The neonate was subsequently placed in a neonatal intensive care unit for 2 months, while the mother endured a near month-long hospital stay.
Hackney commented that “it’s actually often not safe to take the placenta out, especially if it’s wrapped among some of the blood vessels or the bowel.” In those cases, the placenta is left to degrade inside the abdomen, which takes about 2 weeks. Hackney said that also carries risk.The decision to leave the placenta in situ and partially remove it later was one of the critical choices made to mitigate the significant risks.
Despite the triumph of the baby’s birth and the mother’s recovery, the scenario serves as a sobering reminder of the unpredictability and peril of abdominal ectopic pregnancies. Hackney stressed that this patient’s unusual case does not signify a newfound safety in abdominal ectopic pregnancies, but instead underscores a fortuitous exception in the face of overwhelming odds.
Relevant articles:
– TIL of hepatic pregnancy, where the site of implantation occurs in the liver.
– Baby Delivered From Rare Abdominal Ectopic Pregnancy, Medpage Today, Mon, 18 Dec 2023 08:00:00 GMT
– Defying the Odds: A Rare Case of Abdominal Ectopic Pregnancy in France, Medriva, Fri, 15 Dec 2023 08:00:00 GMT
– Syphilis, World Health Organization (WHO), Wed, 31 May 2023 07:00:00 GMT