PLACENTAL ABRUPTION IN ASSOCIATION WITH ADVANCED ABDOMINAL PREGNANCY - A CASE-REPORT

BACKGROUND: Recognition of advanced abdominal pregnancy and care of th e patient afflicted with it may present formidable challenges. Aside f rom the difficulty of diagnosing the problem and thereby delaying nece ssary intervention, management can be difficult at best, even when the condition is relatively uncomplicated. When it is compounded by a lif e-threatening complication, such as uncontrollable hemorrhage, it chal lenges the skills of the most experienced obstetrician and the resourc es of the best-equipped facility and its personnel. CASE: Partial plac ental separation was encountered at surgery; it progressed intraoperat ively despite the care taken to avoid disturbing the placental implant ation site. Sever hemorrhage was controlled by a combination of aortic compression, packing and use of large ''liver'' sutures incorporating the uterine wall for tamponade of the principal placental implantatio n site, on the mesentery. CONCLUSION: It is important to be prepared t o deal with the complication of intense intraabdominal bleeding in the course of intraoperative management of abdominal pregnancy.