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Expectant management of advanced abdominal pregnancies: Is it justifiable?

  • S. Ramphal
    Correspondence
    Corresponding author at: Department of Obstetrics & Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
    Affiliations
    Department of Obstetrics & Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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  • OP. Khaliq
    Affiliations
    Department of Paediatrics and Child Health, Faculty of Health Sciences, The University of the Free State, Bloemfontein 9300, South Africa
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  • T. Abel
    Affiliations
    Women’s Health and HIV Group, Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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  • J. Moodley
    Affiliations
    Women’s Health and HIV Group, Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Published:December 24, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.12.023

      Abstract

      Objective

      To evaluate the outcome of a case series of women with advanced abdominal pregnancies (AAP) who underwent expectant management.

      Study design

      A retrospective study that utilized prospective data of 46 women who were admitted for expectant management at a tertiary hospital in Durban, South Africa. All data was analyzed descriptively and presented in percentages.

      Results

      The average period of expectant management was 27 days; thirty-three (72 %) of the 46 women were discharged from the hospital with live babies. There were 11 (24 %) neonatal deaths and two cases of stillbirths. There were no maternal deaths and morbidity was minimal.

      Conclusion

      When diagnosed after the 24th week of gestation, an option is expectant management which includes careful patient selection, prolonged hospitalization, and close antenatal fetal and maternal surveillance to achieve fetal viability. Management by experienced clinicians and a multidisciplinary team in a tertiary institution is recommended. Informed consent needs to take into consideration the risks with interventional laparotomy, social separation from family and friends, and the guarded perinatal outcome.

      Keywords

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