Rare ectopic pregnancy in the liver in Namibia- Africa

Rare ectopic pregnancy in the liver in Namibia- Africa 

Few days ago a colleague of mine showed the video of a real time pregnancy in the liver, I couldn’t believe my eyes. I did some research and I forwarded the video to sonographers group on Facebook, that caused a stir of international interest. 99.9% of experienced sonographers have never seen it before, 90% had never heard about it. Now I can imagine how ignorant the general public is about this.

 

This case was reported in Namibia on the 13th December, 2018. Below is a documented case in the literature to enlighten the reader.

The video below is a recent finding in Namibia

Reported case

 

Primary hepatic pregnancy

Reena Yadav, Chitra Raghunandan, and Sarita Chowdhary
Abdominal pregnancy is a rare type of ectopic pregnancy with an estimated incidence being 1 in 8,000 births and 1.4 % of all ectopic pregnancies. Most commonly, the site of implantation in an abdominal pregnancy is pelvic, but very rarely it may implant in the upper abdomen. The authors report such a case of primary hepatic pregnancy on account of its rarity and the therapeutic dilemmas.
Case report
A 25-year-old G2P1L1 woman with 18-week pregnancy presented with right hypochondriac pain and vomiting for the past 1 week. She had borderline vitals and a diffusely tender abdomen. Ultrasound revealed a live 18-week fetus attached to the under surface of the liver with moderate ascites. Laparotomy was carried out which revealed 500 cc of hemoperitoneum with a primary hepatic pregnancy of the right lobe of liver and bleeding from the placental site. After extracting the fetus, the placenta was left inn situ and the abdomen was packed to control the bleeding as other hemostatic measures failed. Hepatic artery embolization was done after surgery followed by relaparotomy but the abdomen had to be repacked again as the patient was unstable with uncontrollable bleeding. The patient succumbed to DIC despite adequate replacement. In retrospect, the authors conclude that embolization could have been done before surgery and partial hepatic resection attempted in the first instance.

 

Intrahepatic cyesis as seen in Namibia

 

Article information credits 

J Emerg Trauma Shock. 2012 Oct-Dec; 5(4): 367–369.
PMCID: PMC3519057
PMID: 23248513
Department of Obstetrics and Gynaecology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
Address for correspondence: Dr. Swati Agarwal, E-mail: moc.liamg@liamitawsrd
You can also read other case
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. 2012 Feb; 1(1): 40–44.
PMCID: PMC4204586
PMID: 25343072
Imaging diagnosis of hepatic ectopic pregnancy: A report of one case
This article is about a case of hepatic ectopic pregnancy. A patient suffered from an acute abdomen with 14-day vaginal bleeding. A serum, human chorionic gonadotrophin (HCG) of 8,988 mIU/mL revealed a bit of pelvic effusion. A computed tomography (CT) plain scan displayed a polygonal, moderate density shadow of the left liver lobe. An enhanced CT had no sign of intensification. A magnetic resonance imaging (MRI) plain scan was undertaken. On a T1-weighted imaging (T1WI), the lesion appeared to be a low signal; on a T2-weighted imaging (T2WI), the lesion appeared to be a high signal. With enhanced MRI, the lesion showed an irregular mild plague-like intensification during the venous phase. It was excised by an operation and chorionic tissue was seen under a microscope. The result of pathological diagnosis was hepatic ectopic pregnancy.
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also read
 2007 Feb;109(2 Pt2):544-6.
Diagnosis and management of hepatic ectopic pregnancy.
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Miracle baby ‘grew in liver’
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The baby developed outside the womb

A healthy baby has been born after developing in its mother’s liver instead of in the womb.Reports from South Africa say Nhlahla, whose name means “luck” in Zulu, is only the fourth baby ever to survive such a pregnancy.

In all, there have only been 14 documented cases of a child developing in this way.

Nhlahla was born after specialists performed a difficult operation to deliver her on Tuesday.

 The mother is at a huge risk 
Professor James Walker, Ectopic Pregnancy Trust,

She had to be put on oxygen after her birth, where she weighed a healthy 2.8kg, but was breathing without aid by Thursday.

Doctors said Nhlahla and her mother Ncise Cwayita, 20 – whose first baby was born normally – were both doing well.

Liver specialist Professor Jack Krige, who helped deliver the baby, told a South African newspaper: “She is the real thing. She is truly a miracle baby.”

Risks

When an egg is fertilised, it normally travels down the fallopian tube to the womb, where it implants and grows.

But sometimes, the embryo implants in the fallopian tube, a standard ectopic pregnancy.

In some cases – around one in 100,000 pregnancies – it falls out of the fallopian tube and can implant anywhere in the abdomen.

In extremely rare cases, such as this one, the embryo attaches itself to the liver, a very rich source of blood.

The baby is protected because it is within the placenta – but it does not have the usual protection of the womb – and is at more risk in the abdominal cavity.

Most babies in extrauterine (out of the uterus) pregnancies die within a few weeks.

Window

In this case, doctors only discovered the baby was growing in the liver when they performed a scan this week.

Her womb was found to be empty, even though her baby was due in a week.

Ms Cwayita was transferred to the Groote Schuur Hospital in Cape Town.

Dr Bruce Howard told the Cape Argus newspaper said: “We knew it was an extrauterine pregnancy but we didn’t know it was in the liver until we started the operation on Tuesday morning.”

Doctors found a small “window” where the amniotic sac connected with the outside of the liver where they were able to go in to deliver the baby.

Doctors had to leave the placenta and amniotic sac in the liver, because the mother’s life would have been at risk.

It is expected they will be absorbed back into her body.

Professor James Walker, president of the British Ectopic Pregnancy Trust, told BBC News Online abdominal pregnancies could be very dangerous.

“The mother is at a huge risk. One in 200 women die before we can do anything to help them.

“The main problem for the baby is that it is not protected by the muscular wall of the womb.” 

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