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Failure of cervical ripening prior to labour induction at term: a clue to extrauterine position of the fetus

Olufemi T. Oladapo

CaseRepClinPractRev 2006; 7:129-131

ID: 451687

Background: Secondary abdominal pregnancy progressing to term is a rare life-threatening condition, which
presents a major diagnostic and therapeutic challenge to clinicians particularly those practising in resource-poor settings. The extremely variable clinical presentation and the non-specific
physical findings often result in delay in diagnosis and prompt intervention. Awareness of the various modes of clinical presentation is essential to avoid the imminent risks of perinatal and maternal mortality.
Case Report: A 33 year-old multipara referred from a private hospital on account of failure of cervical
ripening with transcervical Foley’s catheter prior to induction of labour for a postdate pregnancy.
Attempt to ripen the cervix with the Foley’s catheter lasted for 72 hours during which the patient developed generalised abdominal pain and noticed cessation of fetal movements. The diagnosis of abdominal pregnancy was later suspected after repeated doses of 50 μg intravaginal misoprostol at the referral centre did not improve the cervical Bishop’s score. A transabdominal ultrasound examination confirmed the diagnosis of abdominal pregnancy and the woman had an emergency exploratory laparotomy. At surgery, a dead male fetus weighing 3 kg was delivered and the placenta was completely removed with minimal difficulty. The woman
was transfused with a total of six units of whole blood and was discharged home on the 22nd
postoperative day.
Conclusions: Failure of the cervix to ripen at term using the conventional methods of cervical ripening
should urgently indicate re-evaluation of the exact location of the fetus regardless of its state
of health.

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