World Journal of
Pharmaceutical and Life Sciences

A LARGE AMNIOCELE WITH PROTRUDED RIGHT ARM AND HEMITHORAX: A CASE REPORT AND REVIEW OF THE LITERATURE

Jamal EL Azzaoui*, Nadia Chmichi, Aziz Slaoui, Soukaina Khalta, Sara Talib, Anas NAH, Najia Zeraidi, Amina Lakhdar, Aicha Kharbach and Aziz Baydada

ABSTRACT

Uterine rupture is a rare but serious peripartum complication associated with high rates of maternal and fetal death. Spontaneous silent rupture of the intact uterus is exceptional. Amniocele which is defined by the herniation of the amnion through a uterine defect is another extremely rare condition. We hereby report an uncommon case of an asymptomatic 38-year-old woman (gravida 3 para 1 with 1 live child) who presented with a large amniocele detected at 22th weeks of gestation by routine ultrasonography. After informing the patient and her husband about the potential risks of complete uterine rupture and eventually hysterectomy, it was decided by mutual agreement to continue the pregnancy in our facility. The herniated amniotic sac continued to increase as the pregnancy advanced. Consequently, a scheduled cesarean section was performed at the 29th week of gestation which allowed the cephalic extraction through the uterine defect of a male newborn, Apgar score at 1 and 5 minutes were 10 and 10 respectively, birth weight 1500g. Patient’s recovery course was uncomplicated. Patient and newborn were discharged home on postoperative day-4. A review of the literature was then made and all cases of amniocele before 34 weeks of gestation were studied. The management of amniocele depends on several factors including the desire to continue the pregnancy of the family, term at the time of diagnosis, fetal viability, severity of symptoms, thickness and size of uterine defect. Therapeutic strategies can be classified into three categories: termination of pregnancy, surgical repair of uterine defect, and expectancy with strict supervision. Amniocele is an uncommon pathology whose management is complicated. Practitioners need to adopt the best course of action depending on the situation: surgical repair when possible remains the method that has shown the best results, but the expectant attitude with strict supervision can also be beneficial and preserve the pregnancy.

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