“Rarest of the rare”: ectopic growth of a fetus in a 37-year-old pregnant woman; The child survives!

“Rarest of the rare”: ectopic growth of a fetus in a 37-year-old pregnant woman;  The child survives!

MRI of a baby in his mother’s womb

(Gorencourt et al., NEMJ, 2023)

Imagine making a visit to the emergency room while having some painful cramps, anticipating antacids and a pep talk, and then coming out with a pregnancy announcement.

Although this prospect is terrifying, it is not uncommon. There have been cases where women did not know they were pregnant until it was time to give birth. However, what happened to a 37-year-old woman from Reunion, an island east of Madagascar, was far more shocking than a normal surprise pregnancy – because the fetus was outside her uterus!

You heard that right. Scans revealed that the healthy 23-week-old fetus had decided to camp directly above its mother’s bone, abandoning the uterus entirely. This was a big problem.

David Hackney, a specialist in maternal-fetal medicine at Case Western Reserve University in Cleveland, described this condition as “the rarest of rare cases,” and said he had never seen it in person.

These conditions are called ectopic pregnancies, and they are almost always fatal to the baby and lead to miscarriage. This is because tissues outside the uterus, such as the fallopian tubes, do not provide enough blood supply and support to the fetus. The structure holding the fetus usually ruptures after about 6 to 16 weeks.

In less than 1% of ectopic pregnancies, the fertilized egg ventures into the vast expanse of the abdominal cavity, attaches itself to the peritoneum, spleen or other organs and forms a placenta for itself. As the fetus grows, its unsupported weight and the pressure it exerts on the surrounding organs threatens its growth and the mother’s health. After 20 weeks, the risk of maternal death from shock, bleeding and organ failure could rise to a alarming level of one in five.

The fact that this pregnancy was already 23 weeks meant that doctors had to act quickly. At 29 weeks, the woman was transferred to a more appropriate hospital, where the infant was delivered surgically and transferred to intensive care. Two months later, mother and child were happily reunited.

“The standard recommendation, if you find this earlier, is generally considered too dangerous to come forward with. This is a lucky patient who could have died, you know. It seemed like things went well, but this was a very close decision,” Hackney said.

Why the rebellious fetus left the womb in the first place remains a mystery. Previous medical conditions such as endometriosis or even certain infections may have led to this irregularity. But in this case, the mother’s medical history offers no clues, leaving us with a fascinating medical mystery wrapped in a bundle of joy.

This story is a testament to the amazing resilience of both the human body and the medical field. It’s a reminder that even the most extraordinary deviations from the norm can sometimes have happy endings.

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