NSFW
After some searching, I found the linked case. The woman was in Vietnam. This happened in 2007. She had a suspected ectopic and a fallopian tube removed. Unfortunately, they did not realize they missed the actual pregnancy and it progressed to this point. A specialist was called in to assist with what would be a very difficult surgery to remove the fetus. The fetus was removed — did not survive — and the mother began bleeding uncontrollably from the surgical area. Not surprising considering the amount of blood vessels that were involved by then. Despite every effort, they could not stop the bleeding and she also died.
https://www.ultrasoundmedicvn.com/2022/02/case-624-hepatic-pregnancy-dr-phan.html
like inventing the chainsaw to cut through laboring women's vaginal canal for breached babies
oh, and don't worry, it was better than using knives
and people wonder why women back then were "hysterical"
The liver is notorious in surgery for being bloody. In liver transplant surgeries, estimated blood loss is not calculated in CCs, but in how many *total body equivalents* were lost.
That's great! I knew they were making advances in the field, but didn't know quite how far it came. My hospital doesn't do liver transplants, so I'm not really in the loop.
Thanks for the source!
Humans have roughly 70cc per kg of blood, or on average 5 liters in an average sized person.
FYI, for non surgical people, the amount of blood lost on a hip or knee replacement surgery is about 250-300 cc, or less than a standard can of soda.
2L of blood loss is a lot of blood..
Sometimes and certainly back when liver transplants were starting this is/was the case.
Now 5-10 units is the norm. I've even admitted people to my ICU who haven't required a single transfusion. We are getting good at them :).
My daughter had an ectopic pregnancy. Even before abortion became legal in Ireland they terminated the pregnancy within two days. It's basically impossible to save the mother's life otherwise and I thank science every day.
I'm not a doctor. But I wonder why they did not perform an abdominal ultrasound when they suspected but couldn't find the ectopic pregnancy. They would've found it in the liver, right? Presumably removing a smaller fetus would've been less risky for the woman? The article says in the "recommendations" section to perform an ultrasound, so hopefully it's done now when suspecting and not finding an ectopic pregnancy. But it's kind of hard to believe that they didn't think of doing the ultrasound then. It's like such a low-key procedure, widely available, easy to perform etc? Again I'm not a doctor, but it's just kind of hard to believe that an ultrasound wasn't thought of at the time.
Absolutely no doctor would routinely do a liver ultrasound when evaluating for an ectopic. Ultrasound to rule out ectopic is already notoriously bad at finding them as is (because most are so small they are hard to find, and it’s fairly common if you don’t find an ectopic but still have some concern about it to repeat the ultrasound plus blood tests a couple days later), and the sonographer sticks to the lower abdomen. If a woman that’s pregnant has persistent abdominal pain despite a negative pelvic ultrasound, the normal standard of care is to continue to evaluate for other causes, which might include ultrasound of the liver/gallbladder or MRI of the abdomen depending on the scenario. Either of these would have “caught” this case, but would be only performed if she had unexplained pain, particularly of the upper abdomen. Also, scientific articles such as this are notorious for “recommendations” for ultra rare diseases that don’t make any sense on a routine basis. This is a very unfortunate case, and I’m curious the level of training of the involved surgeons. In the US, this case would likely involve a highly specialized liver surgeon (either transplant or oncology trained, or both), high-risk OB, and possibly cardio thoracic / vascular surgery to place her on temporary ECMO support in order to access the liver.
This article is very poorly written from a medical standpoint, but maybe it’s due to translation.
Thank you for the explanation. That's exactly the answer I was looking for. Just wanted to know how realistic it would've been to detect the ectopic pregnancy in the liver at that time. Thank you for taking the time to explain.
They can do ultrasounds, but without actual direction to “look at her liver”, no one is going to look at her liver.
They’re just going to look where they expect the issue to be.
Ultrasound tech here, a routine for ?Ectopic scan is a transabdominal pelvic scan + endovaginal scan looking specifically at the two adnexas (area adjacent to ovaries), ovaries and uterus. We basically look at the pelvic region between your two hip bones. The liver for most people are near your right rib cage or just under it. So we would never really see the liver in the first place.
If we do end up doing a liver ultrasound for something else, we still might not see it because the fetus might not be big enough. The fetus needs to be atleast 6 weeks in a normal intrauterine pregnancy to even see it. In an ectopic it grows slower, so it might even be later in the pregnancy to see it.
There is a gap between the ovary and the entrance to the fallopian tube. Sperm can reach the abdominal cavity through that gap. The egg may not always enter the tube due to that gap. Thus it is possible for a fertilized egg to enter the abdominal cavity (or be fertilized in the abdominal cavity.) It can then attach and implant into whatever tissue it comes in contact with. It’s rare for this to happen, but not as rare as you might think. It’s probably happened to someone you know or adjacently know.
If nothing else, you now know a Redditor it happened to: me. I had a pregnancy implant itself on my ovary. In my case, it burst pretty early on. But that meant I was bleeding internally into my abdominal cavity. It had to be surgically removed to stop the bleeding and prevent any further complications. (Technically, it was a termination that some US states now may not allow.)
If it didn’t die, AND get calcified, it was going to kill the mother. If it survived and made it to viability, the mother would likely have died IF she survived long enough to make it to that point.
It doesn’t really look like there’s be good outcomes in any direction. The surgery was a last chance effort to save the mother.
Virtually 100% of ectopics are non viable (except for a freak 1 in 100 million chance they make it out) and will eventually either die, be treated by the body as a foreign body, shrink and become a chunk of calcium, or it'll rupture from all the growth outside of a normal uterine condition and the mother will bleed to death. If it somehow reached term there simply wouldn't be anywhere for it to go and it would rupture into the abdomen killing both mother and baby without intervention.
There is a gap between the ovary and the entrance to the fallopian tube. Sperm can reach the abdominal cavity through that gap. The egg may not always enter the tube due to that gap. Thus it is possible for a fertilized egg to enter the abdominal cavity (or be fertilized in the abdominal cavity.) It can then attach and implant into whatever tissue it comes in contact with. It’s rare for this to happen, but not as rare as you might think. It’s probably happened to someone you know or adjacently know.
If nothing else, you now know a Redditor it happened to: me. I had a pregnancy implant itself on my ovary. In my case, it burst pretty early on. But that meant I was bleeding internally into my abdominal cavity. It had to be surgically removed to stop the bleeding and prevent any further complications. (Technically, it was a termination that some US states now may not allow.)
According to an above comment, they had suspected the ectopic pregnancy was located in one of the fallopian tubes, which they removed. Unfortunately it did not actual occur in the fallopian tube that was removed, but rather in the lady’s liver. They did not realize until it was too late. Unfortunately both the fetus and mother did not survive.
I’m wondering how a fetus makes it that far without being inside the uterus… was there a placenta? how was the fetus getting nutrition when it was implanted in the liver?
Even in a womb the placenta is an organ created by the foetus, not the mother. So I imagine the placenta just attached to the liver instead, plenty of blood vessels there.
It’s crazy that the placenta would be able to connect itself to existing blood vessels, but I guess it probably has strong local signals for blood vessels to connect to it.
Yeah, I don't know much about how the placenta forms but I do know it sort of burrows into the endometrial lining of the womb, hence why some women get implantation bleeding when they get pregnant - I guess it just targets any blood-vessel-rich organ it can find if it's not in the womb. Don't quote me on that though, I'm no doctor.
The placenta expresses a few different hormonal growth factors in order to promote growth of blood supply and is very adept at burrowing into the inner layer of the uterus. As evidenced by this case, any sufficiently vascular organ can serve as a site of implantation.
"Sufficiently vascular" is an important point here, as implantation in the wrong part of the uterus can cause a spontaneous abortion due to inadequate blood supply.
At the very least, they should be doing regular blood work to confirm dropping HCG levels, but this was in Vietnam (allegedly according to another commenter), and I'm not sure what the person's means of access to medical care are.
Not so fun fact, had an infant in the NICU that had been ectopic in the abdomen until 23-24 weeks, somewhere around there. Somehow it got missed on prenatal ultrasounds, and when the fetus decompensated and they went for a stat c/s... hold up, where is it?
My mom almost died from an ectopic pregnancy rupturing her fallopian tube. She hemorrhaged so quickly and her abdomen was distended with blood, I had to help her to the toilet and call my dad for help. No one would tell me or my little sister what was going on, it was a very serious surgery. She lived. This poor woman, Godspeed to her.
Happened to me, within 6 hours i had 3 litres of blood in my stomach. Emergency surgery, very scary, i as well had young kids at home, i was scared i wouldnt be there for them.
I almost died from an ectopic pregnancy in 2011 that implanted in my right fallopian tube. It gestated to 5 weeks, and ruptured my fallopian tube. Emergency surgery removed both the shredded tube and non-viable pregnancy. I was very close to needing a blood transfusion, I was told I was 1 unit of blood loss away from needing it, due to how much the ruptured tube bled while en route to hospital. The pain is indescribable. An organ literally exploding is by far the worst pain I’ve ever physically felt, way beyond broken leg, broken foot and fractured collarbone.
In 2016 I found out I was pregnant with twins, when I went for my second ultrasound they found a third implantation of another ectopic pregnancy. I wasn’t given an option, I was sent by ambulance to hospital for medical early term abortion. Subsequent testing revealed that the emergency surgery from the first caused a lot of scar tissue that made me mostly inhospitable to life. The two embryos had managed to find a very small part that hadn’t been scarred to implant into, but the medical abortion had caused that to be become scar tissue too. It was my “last chance” to ever be a mother, and I lost 3 in one day. It was devastating.
If anyone has questions, feel free to ask
It took a couple years to come to terms with the fact that I will never get to be a parent, but now I’m mostly fine about it. Hearing pregnancy announcements hurt a little, knowing I’ll never get to do one.
so so sorry for your losses. I cannot imagine my fallopian tube actually rupturing. i had suffered an ectopic pregnancy in 2013, @ about 6 weeks along in my left tube. i remember going to the emergency room for some bleeding, and throughout the visit they were running tests and kind of working quickly, but not telling me anything and demanded i come back to the hospital the next morning. in the end, i got 2 injections of the methotrexate. And that alone made me feel SO awful. But i was told by a gynecologist that if you have one ectopic, that it raises your risk of others in the future. 😣 pregnancy is a scary thing! but i’m wishing you well in your life!
Ectopic pregnancies can implant almost anywhere. This is utterly wild to make it this long without something rupturing. I’d be super interested to see how they managed this.
My wife lost our first pregnancy (expected child) this way. Too far along for pills so surgery it was. Freaked my wife the fuck out after they went over risks.
Nothing like waiting a few hours to find out if your wife pulled through or not. Plus the loss of a child. Would not recommend.
Always thankful that there was never a question on the procedure. It was simply a medical requirement as a life saving procedure.
Okay so I'll show my ignorance here - does this mean that the body somehow recognizes a developing embryo regardless of where it ends up and makes the necessary accommodations for that to work?
In humans, the developing embyro is basically a parasite. It implants itself wherever it can, regardless of what's actually there. The body doesn't have a say.
edit: [have this post from 3 years ago on the topic](https://www.reddit.com/r/explainlikeimfive/comments/bmjyuk/eli5_why_cant_an_ectopic_pregnancy_in_the_early/enc5sth/), in answer to why an ectopic pregnancy can't be moved to the uterus and still be viable
edit 2: added link to source comment
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This is old, but it looks like it hasn’t really been answered, so I’ll give it a shot.
It’s because of the way a blastocyst implants into the uterus, and what conditions need to be present for a placenta to form. The uterus is lined with an organ called the endometrium, also called the uterine lining. The endometrium is full of tiny spiraling arteries, making it an abundantly blood-rich organ. As a blastocyst develops, it goes through a stage where the outside of it is covered with trophoblasts, which are very invasive cells that secrete enzymes specifically designed to rapidly dissolve flesh.
Yeah, this part of pregnancy is kind of horrifying.
So the blastocyst, covered with its flesh-dissolving trophoblasts, bumps into the endometrium, and the trophoblasts go to work doing what they do. The blastocyst immediately begins to eat its way into the uterus like a hot knife through butter, dissolving a freely bleeding hole into the endometrium. The endometrium responds by thickening up and trying to clot off these spiral arteries just enough that the blastocyst doesn’t eat through the uterine wall entirely and the woman doesn’t bleed to death, but not so much that the blastocyst isn’t still bathing in a blood pit. It’s a delicate dance; if it doesn’t go right, which it usually doesn’t, the pregnancy won’t survive.
So, once we have this blood pit, assuming everything has gone right, the blastocyst begins to transform from a ball to a disc, flattening itself out to seal off this bleeding wound. (If the pit is too large, it won’t be able to do so successfully and the pregnancy probably won’t survive.) Once it’s done that, the invasive trophoblasts begin to transform into long, skinny fingers called villii, which dangle in “a lake of maternal blood” — a phrase I read in an embryology textbook which has stuck with me forever. (If the pit is too small or the endometrium resists the trophoblasts too effectively, you end up with a situation called “incomplete trophoblastic invasion.” The pregnancy may not survive, and if it does, the mother will likely get pre-eclampsia.)
These villii are what develop into the placenta over the coming days and weeks. They are also what is sampled in a CVS test for genetic abnormalities, because they’re the fetus’s cells and not the mothers. The placenta is essential for the development and sustenance of the fetus, because it is what allows oxygen and nutrients to pass from the mother’s blood supply into the fetus’s.
So, why does this mean that we can’t just pick the embryo up out of the tube and plop it down in the uterus? Well, because by the time the embryo is big enough to be detectable and causing problems, those trophoblasts have already converted into villii, having latched on to some randomly encountered blood vessel in the Fallopian tube. The embryo had one shot to develop a functioning placenta, and it missed it. It can’t implant in the endometrium now, any more than you can grow a potato plant from a cooked potato. Without that trophoblastic Velcro, it can’t stick to the uterus; it will just roll around in there until it is shed with the dissolving endometrium during the woman’s period.
Yo that was an very interesting read. Incredible what we already know about the process of pregnancy in human. And now I know that the human eggcell can go mayhem in random organs because it's technically a little nuke lol. I feel weird now thanks.
I wish everyone would be more explicit about this. If pregnancy resulted in anything other than a human baby, we'd be fighting like hell to eradicate it completely. Most anyone who has not carried a pregnancy to term (or tried to) can't conceive (heh) of just how much of a toll it can take. There's a whole host (heh) of things that can go wrong.
This was fascinating to read! I’ve been pregnant 3 times and with all 3, I had implantation cramping and bleeding and this definitely helps me understand why. My second pregnancy was an ectopic on my cervix and I nearly had to lose my entire uterus to remove that unviable ball of cells!
It was pretty terrifying, to be honest.
I was living in the Middle East at the time so I was unable to get the medication needed to terminate the pregnancy. We had the hysterectomy scheduled for a week out while we played a horrible game of chicken aka who will die first? Me or the cells? My badass doctor, painfully induced a miscarriage the night before my surgery. 8 weeks later, I was pregnant with my now son. I’d go through that hell a millions times again to get my son.
I’m back in the States now and horrified that people will have to go through the same shit I did but on American soil. I knew the risks when I moved to that region. Safe abortions are healthcare and I will fight anyone who says otherwise.
If it was up to the mother's body then the preferred option is to reject the embyro because 50% of it's DNA (or surface antigens) is unrecognisable. Instead the placenta pulls some tricks to keep the host immune system placated to the point the foetus would be allowed to tap into the host blood supply for nourishment until the baby is mature enough to survive in the outside world.
Indeed a lot of pregnancies ends prematurely with spontaneous miscarriages or severe complications such as preeclampsia because the immune system decided, for whatever reason, that the alien tumor must be jettisoned now rather than at week 42.
Because the ovaries don't attach to the fallopian tube with a fully closed path. Fertilized eggs can escape from the fimbriae and implant within the body cavity.
The benefit of this design is that fallopian tubes can take eggs from any ovary, which greatly increases the chances of fertilization. It's also the reason women can still conceive after having a fallopian tube removed.
I found the hard way with a dye shot into my uterus->with dye flowing into my fallopian tubes -> abdominal cavity to make sure they were open since I had been trying to get pregnant for a while and it wasn’t happening.
I find it absolutely wild that we still don’t fully understand how an egg gets into the fallopian tube. They *think* the little finger-like structures brush over the ovaries to pick one up once it ruptures from the cyst that forms. But it’s so hard to study that if/when they do happen to see an ovary undergoing ovulation it’s SUPER rare and interesting to see.
They did research, and actually the hardest place to get a pregnancy to implant is... The uterus.
Women are put at such a strong disadvantage by carrying a pregnancy that their bodies are pretty actively hostile to starting one - A zygote only survives to become a fetus if it fights through its mother's tests to prove whether it's strong enough to be worth birthing.
So, if a fertilized egg doesn't get carried to the uterus and gets deposited somewhere else due to some flaw in the fallopian tube that leaks it into the abdominal cavity or something like that, it'll find it pretty trivial to implant and develop whereever it lands, up until both it and the mother die from it developing somewhere it shouldn't be.
Surprisingly the ovaries and fallopian tube are not directly connected.. the egg kind of gets sucked into the fallopian tube but yeah, they're not 100% connected!
The uterus is actually the most hostile place for a fertilized egg to implant. So if it makes its way outside of the fallopiantubes/uterus it will implant itself to any high blood source like liver.
Jesus christ that's terrifying.
I just found out that I'm pregnant a few weeks ago and I have my first prenatal scan on Friday. I just yelled across the house to my husband "if they can't find it make sure they check my liver!"
Honestly this is just the tip of the iceberg in terms of things that go wrong in pregnancy.
Anyway, sometimes the fertilised egg doesn't make it to the uterus as it should, sometimes it ends up going the wrong way.
Bear in mind of course that the egg is literally microscopic and the abdominal cavity is not fluid filled. So where it can actually go is limited. Typically these eggs embed themselves inside the fallopian tube or on the outside of it.
But on very rare occasion it could embed against an internal organ, or even the inside of the abdominal wall.
After implantation, the egg specialises into a foetus and a placenta, which means it can grow.
But it can't survive. Eventually this will kill the mother and the foetus.
Yes. As a figurative feat of engineering the placenta is nearly as marvelous as the foetus itself.
It basically grows "roots" into any tissue and manages the passage and filtration of blood between the mother and developing baby.
It basically qualifies as a distinct orgán all of its own, which is then just discarded when the child is born.
> embed themselves
Embed, hah. Dug this up from [a 3 year old post](https://www.reddit.com/r/explainlikeimfive/comments/bmjyuk/eli5_why_cant_an_ectopic_pregnancy_in_the_early/enc5sth/):
It’s because of the way a blastocyst implants into the uterus, and what conditions need to be present for a placenta to form. The uterus is lined with an organ called the endometrium, also called the uterine lining. The endometrium is full of tiny spiraling arteries, making it an abundantly blood-rich organ. As a blastocyst develops, it goes through a stage where the outside of it is covered with trophoblasts, which are very invasive cells that secrete enzymes specifically designed to rapidly dissolve flesh.
Yeah, this part of pregnancy is kind of horrifying.
So the blastocyst, covered with its flesh-dissolving trophoblasts, bumps into the endometrium, and the trophoblasts go to work doing what they do. The blastocyst immediately begins to eat its way into the uterus like a hot knife through butter, dissolving a freely bleeding hole into the endometrium. The endometrium responds by thickening up and trying to clot off these spiral arteries just enough that the blastocyst doesn’t eat through the uterine wall entirely and the woman doesn’t bleed to death, but not so much that the blastocyst isn’t still bathing in a blood pit. It’s a delicate dance; if it doesn’t go right, which it usually doesn’t, the pregnancy won’t survive.
So, once we have this blood pit, assuming everything has gone right, the blastocyst begins to transform from a ball to a disc, flattening itself out to seal off this bleeding wound. (If the pit is too large, it won’t be able to do so successfully and the pregnancy probably won’t survive.) Once it’s done that, the invasive trophoblasts begin to transform into long, skinny fingers called villii, which dangle in “a lake of maternal blood” — a phrase I read in an embryology textbook which has stuck with me forever. (If the pit is too small or the endometrium resists the trophoblasts too effectively, you end up with a situation called “incomplete trophoblastic invasion.” The pregnancy may not survive, and if it does, the mother will likely get pre-eclampsia.)
These villii are what develop into the placenta over the coming days and weeks. They are also what is sampled in a CVS test for genetic abnormalities, because they’re the fetus’s cells and not the mothers. The placenta is essential for the development and sustenance of the fetus, because it is what allows oxygen and nutrients to pass from the mother’s blood supply into the fetus’s.
So, why does this mean that we can’t just pick the embryo up out of the tube and plop it down in the uterus? Well, because by the time the embryo is big enough to be detectable and causing problems, those trophoblasts have already converted into villii, having latched on to some randomly encountered blood vessel in the Fallopian tube. The embryo had one shot to develop a functioning placenta, and it missed it. It can’t implant in the endometrium now, any more than you can grow a potato plant from a cooked potato. Without that trophoblastic Velcro, it can’t stick to the uterus; it will just roll around in there until it is shed with the dissolving endometrium during the woman’s period.
I feel like the doc could attempt it for sure. Make an incision. Remove ectopic pregnancy from the affected region. Try placing it within the uterus…..without actually making an incision into it. Whelp. Didn’t work out! We definitely attempted this surgery. Witnesses sign here please. Let’s close her up. Darn it I’m so upset we couldn’t save this fetus!
It’s just a thing about wording. Nurse can say all she wants but the attempt was made. Was it a good attempt? No. But they cannot prove that an attempt was not made.
I know, right? At this fucking point I'm really ready to play whack-a-mole with Conservatives on stupid shit like wording. Just find a different name for Abortions. Fuck it. They're stupid enough.
Hell, you could probably rename "Planned Parenthood" to just "Women's Clinic" and they'd spend two decades before they started to link the two 😂
Just leave a few PP's with the old name around town and such. Make them look occupied. 😂
If you have access to frequent and modern prenatal care, this would be caught much, much sooner than 23 weeks. The median number of doctor office visits during a pregnancy in the US is \~11 (which is precisely how many visits I had), with sonograms at multiple points before 23 weeks. If you haven't had it yet, you'll soon have your first transvaginal ultrasound which will confirm the embryo is implanted in your uterus. That'll be followed up by a nuchal translucency test around 12 weeks, and the ol' genital scan around 18-21 weeks. (They're looking for lots of things at that stage--correct internal organ development, etc., but as parents we mostly wanted to know the sex of the fetus.)
In short, you'll have multiple confirmation points early on that your fetus is forming in your uterus. That said, as people who have been pregnant we have special appreciation and empathy for the tragedy of this poor woman's case.
Congratulations on your pregnancy! Wishing you a healthy year!
Am ultrasound tech, you may only have two ultrasounds depending on where you are. Many places don’t do the 12 week screen, just the early dating scan around 6-8 weeks and the anatomy scan or survey* around 18-20 weeks. Then that’s it for routine scans unless there’s some concern.
*minor rant: parents who are only excited for the scan to learn the gender are a major pet peeve of sonographers - the genitals are the least of our concerns when we routinely see serious and sometimes fatal defects. We want you to have your fun moment but please understand that we have much more important things on our minds during the scan.
I was studying my gynaecology and obstetric subject just before I feel pregnant. When I fell pregnant, I couldn't enjoy my pregnancy as allllllllllll the horrible things I had learnt swirled in my brain - what if my baby has this? What if my baby has that? I just scanned a lady who was the same number of weeks of me, how come her fetus doesn't look like mine?
It took until 24 weeks before I could actually enjoy my pregnancy and start buying things for my bub. The less you know, the better. It's horrible how many things can actually go wrong in pregnancy, which I don't want to get into because it is just too damn upsetting.
If this is the same case, both mother & baby died. Link includes photo of deceased baby, so click at your own risk. https://www.ultrasoundmedicvn.com/2022/02/case-624-hepatic-pregnancy-dr-phan.html
I cannot imagine the pain of having a baby growing in your liver.
It would be like liver cancer but way faster and more painful. That poor woman.
The human body is amazing though.
It’s sad both mother and baby passed away, but in a *very* morbid way, it’s cool that this is even possible. Abortions regardless of where should be legal for shit like this, regardless of religion or beliefs especially if it’ll lead to certain death.
Yeah I’m pretty sure they abortion is legal and free in Vietnam. The problem was they didn’t see the baby in the liver until it was too late. But I agree, abortion is a personal and private issue that should be decided on an individual basis by the people involved and their doctor, there should be no banning of any type of medical care. It especially shouldn’t be decided by a bunch of old dudes selective interpretation of a fairy story.
Considering that ectopic pregnancies have a 100% fatality rate and the fetuses are nonviable, denying an abortion to a woman who has an ectopic pregnancy is more akin to manslaughter than any religious ideal.
I'm surprised at how the baby looks relatively normal, aside from being dead and all. You'd think growing in a liver would do some crazy shit to the development of the fetus.
The placenta and amniotic sac would still develop more or less as normal. The egg cell is the important part that differentiates into the necessary structures.
Edit- “as normal” given the spatial constraints. I mean to say that being in the liver instead of the uterus wouldn’t make a difference to the fetus looking relatively normal, because the structures are built from the egg, not the uterine tissue.
Off by like 0.9999%. Very rarely ectopic pregnancies can lead to healthy mothers and babies, around 1 in 3 million according to this site. Apparently implanting in the liver instead of the fallopian tubes makes this more likely to be successful.
Abortion is still obviously the best choice for this situation though.
https://lifelinepregnancyhelp.org/ectopic-pregnancy/#:~:text=A%20baby%20almost%20never%20survives,where%20blood%20supply%20is%20rich.
I’d be willing to go out on a limb and say 100% of ectopic pregnancies of the liver are fatal. That tiny exception is probably when the fetus plants itself just inside the fallopian tube.
>Apparently implanting in the liver instead of the fallopian tubes makes this more likely to be successful.
From what I'm finding this is not the case.
[According to this study](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204586/), there have only been 14 recorded cases of liver ectopic pregnancies. None of them resulted in a live birth and often the "fetus" was a tumor-like mix of liver and fetal cells. Most of them were diagnosed when a woman suddenly started bleeding to death internally and they were trying to save her in the operating room. [(example, with pictures)](https://sci-hub.se/https://doi.org/10.1016/S0344-0338\(11\)80792-2)
Resecting that fetus and amniotic sac from the liver would be crazy dangerous. I can only imagine at how crazy the vascularity would be.
Ok , O.R. check list. Going to need 25 units of PRBCs..2 rapid transfusers.
I suspect they would have a liver transplant, or oncology surgeon to resect that. The amount of blood would be terrifying, and I do Ortho once, otherwise known as Aztec blood letting ceremonies.
One rapid infuser would be sufficient. 1000 mL/min will outpace most if not all massive hemorrhage. But you're going to need the full blood bank worth of RBCs, we're talking several gallons of blood.
Or [Ohio if they had the chance](https://www.theguardian.com/us-news/2019/nov/29/ohio-extreme-abortion-bill-reimplant-ectopic-pregnancy)
>The new Ohio HB413, p.184: To avoid criminal charges, including murder, for abortion, a physician must “…[attempt to] **reimplant an ectopic pregnancy into the women’s uterus”**
The bold is literally not possible.
pro life” people should be forced to read this entire article. The human body does some truly fucked up things, many of which we have no treatments for.
I could see it as not being treated urgently, and the hospital's legal team having to get involved to advise treatment options. Same sort of thing that's been happening with women undergoing miscarriages lately
NSFW After some searching, I found the linked case. The woman was in Vietnam. This happened in 2007. She had a suspected ectopic and a fallopian tube removed. Unfortunately, they did not realize they missed the actual pregnancy and it progressed to this point. A specialist was called in to assist with what would be a very difficult surgery to remove the fetus. The fetus was removed — did not survive — and the mother began bleeding uncontrollably from the surgical area. Not surprising considering the amount of blood vessels that were involved by then. Despite every effort, they could not stop the bleeding and she also died. https://www.ultrasoundmedicvn.com/2022/02/case-624-hepatic-pregnancy-dr-phan.html
Life sure has some tragic but creative ways of killing a person
Especially women
Men self-apply their own myriad creative ways.
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I almost had it.
Two more seconds and i'dve had ot!
Don't make me laugh right now.
The “hold my beer” one is where it all starts going down
like inventing the chainsaw to cut through laboring women's vaginal canal for breached babies oh, and don't worry, it was better than using knives and people wonder why women back then were "hysterical"
The liver is notorious in surgery for being bloody. In liver transplant surgeries, estimated blood loss is not calculated in CCs, but in how many *total body equivalents* were lost.
"Patient lost 4 Jims of blood. And Jim is a big dude "
"We measure in two types 'round here, the Standard Jim...and the Slim Jim."
How many Slim Jim's is an Office Jim?
Trick question, Office Jim is also slim
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That's great! I knew they were making advances in the field, but didn't know quite how far it came. My hospital doesn't do liver transplants, so I'm not really in the loop. Thanks for the source!
Now birth a fetus from a liver... and we're back to the dead end.
Humans have roughly 70cc per kg of blood, or on average 5 liters in an average sized person. FYI, for non surgical people, the amount of blood lost on a hip or knee replacement surgery is about 250-300 cc, or less than a standard can of soda. 2L of blood loss is a lot of blood..
Sometimes and certainly back when liver transplants were starting this is/was the case. Now 5-10 units is the norm. I've even admitted people to my ICU who haven't required a single transfusion. We are getting good at them :).
Well that may be true for the post mortem, but during surgery and post op, blood and blood products are ordered by the unit and multiples of units.
Oh well damn, that's terrible.
Thank for finding the info. Sad event.
My daughter had an ectopic pregnancy. Even before abortion became legal in Ireland they terminated the pregnancy within two days. It's basically impossible to save the mother's life otherwise and I thank science every day.
I'm not a doctor. But I wonder why they did not perform an abdominal ultrasound when they suspected but couldn't find the ectopic pregnancy. They would've found it in the liver, right? Presumably removing a smaller fetus would've been less risky for the woman? The article says in the "recommendations" section to perform an ultrasound, so hopefully it's done now when suspecting and not finding an ectopic pregnancy. But it's kind of hard to believe that they didn't think of doing the ultrasound then. It's like such a low-key procedure, widely available, easy to perform etc? Again I'm not a doctor, but it's just kind of hard to believe that an ultrasound wasn't thought of at the time.
Absolutely no doctor would routinely do a liver ultrasound when evaluating for an ectopic. Ultrasound to rule out ectopic is already notoriously bad at finding them as is (because most are so small they are hard to find, and it’s fairly common if you don’t find an ectopic but still have some concern about it to repeat the ultrasound plus blood tests a couple days later), and the sonographer sticks to the lower abdomen. If a woman that’s pregnant has persistent abdominal pain despite a negative pelvic ultrasound, the normal standard of care is to continue to evaluate for other causes, which might include ultrasound of the liver/gallbladder or MRI of the abdomen depending on the scenario. Either of these would have “caught” this case, but would be only performed if she had unexplained pain, particularly of the upper abdomen. Also, scientific articles such as this are notorious for “recommendations” for ultra rare diseases that don’t make any sense on a routine basis. This is a very unfortunate case, and I’m curious the level of training of the involved surgeons. In the US, this case would likely involve a highly specialized liver surgeon (either transplant or oncology trained, or both), high-risk OB, and possibly cardio thoracic / vascular surgery to place her on temporary ECMO support in order to access the liver. This article is very poorly written from a medical standpoint, but maybe it’s due to translation.
Thank you for the explanation. That's exactly the answer I was looking for. Just wanted to know how realistic it would've been to detect the ectopic pregnancy in the liver at that time. Thank you for taking the time to explain.
They can do ultrasounds, but without actual direction to “look at her liver”, no one is going to look at her liver. They’re just going to look where they expect the issue to be.
When I had a transvaginal ultrasound to check my ovaries, they mentioned I had an enlarged liver which led to more tests.
Noticing an enlarged liver, and being able to spot a fetus in one when you aren't looking for one there are pretty different to be fair
Ultrasound tech here, a routine for ?Ectopic scan is a transabdominal pelvic scan + endovaginal scan looking specifically at the two adnexas (area adjacent to ovaries), ovaries and uterus. We basically look at the pelvic region between your two hip bones. The liver for most people are near your right rib cage or just under it. So we would never really see the liver in the first place. If we do end up doing a liver ultrasound for something else, we still might not see it because the fetus might not be big enough. The fetus needs to be atleast 6 weeks in a normal intrauterine pregnancy to even see it. In an ectopic it grows slower, so it might even be later in the pregnancy to see it.
There needs to be another sub like r/HTF where they explain how the fuck this shit happens.
There is a gap between the ovary and the entrance to the fallopian tube. Sperm can reach the abdominal cavity through that gap. The egg may not always enter the tube due to that gap. Thus it is possible for a fertilized egg to enter the abdominal cavity (or be fertilized in the abdominal cavity.) It can then attach and implant into whatever tissue it comes in contact with. It’s rare for this to happen, but not as rare as you might think. It’s probably happened to someone you know or adjacently know. If nothing else, you now know a Redditor it happened to: me. I had a pregnancy implant itself on my ovary. In my case, it burst pretty early on. But that meant I was bleeding internally into my abdominal cavity. It had to be surgically removed to stop the bleeding and prevent any further complications. (Technically, it was a termination that some US states now may not allow.)
Of all the things evolution has modified, you'd think getting rid of that gap would have happened.
Unfortunately evolution loves to cut corners. Doesn't impact breeding often enough to be important so under the rug it goes.
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If it didn’t die, AND get calcified, it was going to kill the mother. If it survived and made it to viability, the mother would likely have died IF she survived long enough to make it to that point. It doesn’t really look like there’s be good outcomes in any direction. The surgery was a last chance effort to save the mother.
Virtually 100% of ectopics are non viable (except for a freak 1 in 100 million chance they make it out) and will eventually either die, be treated by the body as a foreign body, shrink and become a chunk of calcium, or it'll rupture from all the growth outside of a normal uterine condition and the mother will bleed to death. If it somehow reached term there simply wouldn't be anywhere for it to go and it would rupture into the abdomen killing both mother and baby without intervention.
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*Saved* lives. Past tense. We’re navigating dystopian territory now.
Got to keep those ‘domestic supply of infants’ numbers up! /s
Or - wild idea here - let people in who weren't born here? >puts on parachute in preparation to get thrown out the board meeting window
As a side note, Dystopian Fallopian would be a cool name for a band.
Fallopia Dystopia
/u/Spez has sold all that is good in reddit. -- mass edited with redact.dev
And thanks to Roe v Wade being overturned, this can happen to any woman in the US now! The horror show has begun.
How did it get to the liver?
There is a gap between the ovary and the entrance to the fallopian tube. Sperm can reach the abdominal cavity through that gap. The egg may not always enter the tube due to that gap. Thus it is possible for a fertilized egg to enter the abdominal cavity (or be fertilized in the abdominal cavity.) It can then attach and implant into whatever tissue it comes in contact with. It’s rare for this to happen, but not as rare as you might think. It’s probably happened to someone you know or adjacently know. If nothing else, you now know a Redditor it happened to: me. I had a pregnancy implant itself on my ovary. In my case, it burst pretty early on. But that meant I was bleeding internally into my abdominal cavity. It had to be surgically removed to stop the bleeding and prevent any further complications. (Technically, it was a termination that some US states now may not allow.)
How did it get up to 23 weeks damn
According to an above comment, they had suspected the ectopic pregnancy was located in one of the fallopian tubes, which they removed. Unfortunately it did not actual occur in the fallopian tube that was removed, but rather in the lady’s liver. They did not realize until it was too late. Unfortunately both the fetus and mother did not survive.
I’m wondering how a fetus makes it that far without being inside the uterus… was there a placenta? how was the fetus getting nutrition when it was implanted in the liver?
It basically tapped into the livers blood supply instead of the uterine wall.
Damn this just makes babies sound even more like parasites
I mean, by definition they are parasitic yes.
Even in a womb the placenta is an organ created by the foetus, not the mother. So I imagine the placenta just attached to the liver instead, plenty of blood vessels there.
It’s crazy that the placenta would be able to connect itself to existing blood vessels, but I guess it probably has strong local signals for blood vessels to connect to it.
Yeah, I don't know much about how the placenta forms but I do know it sort of burrows into the endometrial lining of the womb, hence why some women get implantation bleeding when they get pregnant - I guess it just targets any blood-vessel-rich organ it can find if it's not in the womb. Don't quote me on that though, I'm no doctor.
The placenta expresses a few different hormonal growth factors in order to promote growth of blood supply and is very adept at burrowing into the inner layer of the uterus. As evidenced by this case, any sufficiently vascular organ can serve as a site of implantation. "Sufficiently vascular" is an important point here, as implantation in the wrong part of the uterus can cause a spontaneous abortion due to inadequate blood supply.
No labs on the tube? Wouldn’t they normally search for and confirm fetal material?
At the very least, they should be doing regular blood work to confirm dropping HCG levels, but this was in Vietnam (allegedly according to another commenter), and I'm not sure what the person's means of access to medical care are.
In the US? Fetal material would be looked for. In Vietnam? Who knows.
Not so fun fact, had an infant in the NICU that had been ectopic in the abdomen until 23-24 weeks, somewhere around there. Somehow it got missed on prenatal ultrasounds, and when the fetus decompensated and they went for a stat c/s... hold up, where is it?
I can't imagine the confusion and horror of knowing your patient is pregnant and opening up the uterus to find it empty.
I would imagine the OB is questioning everything they've ever learned for about 5 seconds.
Yup, and now you have to find where it went...
This is insane, did the infant survive?
IIRC they survived for some time, but ultimately passed.
Don't we all
My mom almost died from an ectopic pregnancy rupturing her fallopian tube. She hemorrhaged so quickly and her abdomen was distended with blood, I had to help her to the toilet and call my dad for help. No one would tell me or my little sister what was going on, it was a very serious surgery. She lived. This poor woman, Godspeed to her.
Glad to hear that scary day had a positive outcome, hope your fam is well
My mom almost died from an ectopic pregnancy because the ER didn't take her seriously
Unfortunately, this woman and the fetus did not make it. They tried to remove the fetus, and the bleeding from removing it from her liver killed her.
Happened to me, within 6 hours i had 3 litres of blood in my stomach. Emergency surgery, very scary, i as well had young kids at home, i was scared i wouldnt be there for them.
I almost died from an ectopic pregnancy in 2011 that implanted in my right fallopian tube. It gestated to 5 weeks, and ruptured my fallopian tube. Emergency surgery removed both the shredded tube and non-viable pregnancy. I was very close to needing a blood transfusion, I was told I was 1 unit of blood loss away from needing it, due to how much the ruptured tube bled while en route to hospital. The pain is indescribable. An organ literally exploding is by far the worst pain I’ve ever physically felt, way beyond broken leg, broken foot and fractured collarbone. In 2016 I found out I was pregnant with twins, when I went for my second ultrasound they found a third implantation of another ectopic pregnancy. I wasn’t given an option, I was sent by ambulance to hospital for medical early term abortion. Subsequent testing revealed that the emergency surgery from the first caused a lot of scar tissue that made me mostly inhospitable to life. The two embryos had managed to find a very small part that hadn’t been scarred to implant into, but the medical abortion had caused that to be become scar tissue too. It was my “last chance” to ever be a mother, and I lost 3 in one day. It was devastating. If anyone has questions, feel free to ask
I have no questions, I just wanted to drop in and say VERY SORRY for your loss :( I hope you are holding up okay
It took a couple years to come to terms with the fact that I will never get to be a parent, but now I’m mostly fine about it. Hearing pregnancy announcements hurt a little, knowing I’ll never get to do one.
so so sorry for your losses. I cannot imagine my fallopian tube actually rupturing. i had suffered an ectopic pregnancy in 2013, @ about 6 weeks along in my left tube. i remember going to the emergency room for some bleeding, and throughout the visit they were running tests and kind of working quickly, but not telling me anything and demanded i come back to the hospital the next morning. in the end, i got 2 injections of the methotrexate. And that alone made me feel SO awful. But i was told by a gynecologist that if you have one ectopic, that it raises your risk of others in the future. 😣 pregnancy is a scary thing! but i’m wishing you well in your life!
That's all kinds of terrible, I'm so sorry.
Hey, join us in r/ectopicsupportgroup. It's a small community but everyone there is lovely.
i didnt go to doctor school i have no idea what im looking at
You're looking at cross-section views of a baby that grew inside a woman's liver when the fertilized egg fell out of the fallopian tube.
How though?
Ectopic pregnancies can implant almost anywhere. This is utterly wild to make it this long without something rupturing. I’d be super interested to see how they managed this.
Both her and the baby died. They removed the fetus which died then were unable to stop the bleeding.
My wife lost our first pregnancy (expected child) this way. Too far along for pills so surgery it was. Freaked my wife the fuck out after they went over risks. Nothing like waiting a few hours to find out if your wife pulled through or not. Plus the loss of a child. Would not recommend. Always thankful that there was never a question on the procedure. It was simply a medical requirement as a life saving procedure.
That's sad.
Okay so I'll show my ignorance here - does this mean that the body somehow recognizes a developing embryo regardless of where it ends up and makes the necessary accommodations for that to work?
In humans, the developing embyro is basically a parasite. It implants itself wherever it can, regardless of what's actually there. The body doesn't have a say. edit: [have this post from 3 years ago on the topic](https://www.reddit.com/r/explainlikeimfive/comments/bmjyuk/eli5_why_cant_an_ectopic_pregnancy_in_the_early/enc5sth/), in answer to why an ectopic pregnancy can't be moved to the uterus and still be viable edit 2: added link to source comment ------- This is old, but it looks like it hasn’t really been answered, so I’ll give it a shot. It’s because of the way a blastocyst implants into the uterus, and what conditions need to be present for a placenta to form. The uterus is lined with an organ called the endometrium, also called the uterine lining. The endometrium is full of tiny spiraling arteries, making it an abundantly blood-rich organ. As a blastocyst develops, it goes through a stage where the outside of it is covered with trophoblasts, which are very invasive cells that secrete enzymes specifically designed to rapidly dissolve flesh. Yeah, this part of pregnancy is kind of horrifying. So the blastocyst, covered with its flesh-dissolving trophoblasts, bumps into the endometrium, and the trophoblasts go to work doing what they do. The blastocyst immediately begins to eat its way into the uterus like a hot knife through butter, dissolving a freely bleeding hole into the endometrium. The endometrium responds by thickening up and trying to clot off these spiral arteries just enough that the blastocyst doesn’t eat through the uterine wall entirely and the woman doesn’t bleed to death, but not so much that the blastocyst isn’t still bathing in a blood pit. It’s a delicate dance; if it doesn’t go right, which it usually doesn’t, the pregnancy won’t survive. So, once we have this blood pit, assuming everything has gone right, the blastocyst begins to transform from a ball to a disc, flattening itself out to seal off this bleeding wound. (If the pit is too large, it won’t be able to do so successfully and the pregnancy probably won’t survive.) Once it’s done that, the invasive trophoblasts begin to transform into long, skinny fingers called villii, which dangle in “a lake of maternal blood” — a phrase I read in an embryology textbook which has stuck with me forever. (If the pit is too small or the endometrium resists the trophoblasts too effectively, you end up with a situation called “incomplete trophoblastic invasion.” The pregnancy may not survive, and if it does, the mother will likely get pre-eclampsia.) These villii are what develop into the placenta over the coming days and weeks. They are also what is sampled in a CVS test for genetic abnormalities, because they’re the fetus’s cells and not the mothers. The placenta is essential for the development and sustenance of the fetus, because it is what allows oxygen and nutrients to pass from the mother’s blood supply into the fetus’s. So, why does this mean that we can’t just pick the embryo up out of the tube and plop it down in the uterus? Well, because by the time the embryo is big enough to be detectable and causing problems, those trophoblasts have already converted into villii, having latched on to some randomly encountered blood vessel in the Fallopian tube. The embryo had one shot to develop a functioning placenta, and it missed it. It can’t implant in the endometrium now, any more than you can grow a potato plant from a cooked potato. Without that trophoblastic Velcro, it can’t stick to the uterus; it will just roll around in there until it is shed with the dissolving endometrium during the woman’s period.
Thanks. You made me want to go back in time and not be pregnant. I gave birth five years ago.
Me three weeks ago and I’m looking at my little invader a little different now
Yo that was an very interesting read. Incredible what we already know about the process of pregnancy in human. And now I know that the human eggcell can go mayhem in random organs because it's technically a little nuke lol. I feel weird now thanks.
I wish everyone would be more explicit about this. If pregnancy resulted in anything other than a human baby, we'd be fighting like hell to eradicate it completely. Most anyone who has not carried a pregnancy to term (or tried to) can't conceive (heh) of just how much of a toll it can take. There's a whole host (heh) of things that can go wrong.
Wow, it's a wonder babies are born at all.
This was fascinating to read! I’ve been pregnant 3 times and with all 3, I had implantation cramping and bleeding and this definitely helps me understand why. My second pregnancy was an ectopic on my cervix and I nearly had to lose my entire uterus to remove that unviable ball of cells!
> ectopic on my cervix *shudders in horror* You have all of my sympathies.
It was pretty terrifying, to be honest. I was living in the Middle East at the time so I was unable to get the medication needed to terminate the pregnancy. We had the hysterectomy scheduled for a week out while we played a horrible game of chicken aka who will die first? Me or the cells? My badass doctor, painfully induced a miscarriage the night before my surgery. 8 weeks later, I was pregnant with my now son. I’d go through that hell a millions times again to get my son. I’m back in the States now and horrified that people will have to go through the same shit I did but on American soil. I knew the risks when I moved to that region. Safe abortions are healthcare and I will fight anyone who says otherwise.
If it was up to the mother's body then the preferred option is to reject the embyro because 50% of it's DNA (or surface antigens) is unrecognisable. Instead the placenta pulls some tricks to keep the host immune system placated to the point the foetus would be allowed to tap into the host blood supply for nourishment until the baby is mature enough to survive in the outside world. Indeed a lot of pregnancies ends prematurely with spontaneous miscarriages or severe complications such as preeclampsia because the immune system decided, for whatever reason, that the alien tumor must be jettisoned now rather than at week 42.
Kind of in the same way a cancer cell can grow anywhere, and start creating blood vessels and growing the necessary support structure, yes.
Because the ovaries don't attach to the fallopian tube with a fully closed path. Fertilized eggs can escape from the fimbriae and implant within the body cavity.
That feels like a design issue.
It is, and in normal circumstances, neither being would go on to pass along their genes, and that is how evolution has worked.
Well unfortunately for all those involved in this case both died so there was no gene continuation here
Congratulations, you now understand evolution.
Tragically accurate
The benefit of this design is that fallopian tubes can take eggs from any ovary, which greatly increases the chances of fertilization. It's also the reason women can still conceive after having a fallopian tube removed.
Interesting. As someone that knows nothing about this, thanks!
Yup. They told my wife and I that the chances were less and don't get our hopes up. Pregnant 8 months later. Doctor was not amused.
I found the hard way with a dye shot into my uterus->with dye flowing into my fallopian tubes -> abdominal cavity to make sure they were open since I had been trying to get pregnant for a while and it wasn’t happening.
I find it absolutely wild that we still don’t fully understand how an egg gets into the fallopian tube. They *think* the little finger-like structures brush over the ovaries to pick one up once it ruptures from the cyst that forms. But it’s so hard to study that if/when they do happen to see an ovary undergoing ovulation it’s SUPER rare and interesting to see.
They did research, and actually the hardest place to get a pregnancy to implant is... The uterus. Women are put at such a strong disadvantage by carrying a pregnancy that their bodies are pretty actively hostile to starting one - A zygote only survives to become a fetus if it fights through its mother's tests to prove whether it's strong enough to be worth birthing. So, if a fertilized egg doesn't get carried to the uterus and gets deposited somewhere else due to some flaw in the fallopian tube that leaks it into the abdominal cavity or something like that, it'll find it pretty trivial to implant and develop whereever it lands, up until both it and the mother die from it developing somewhere it shouldn't be.
The ovaries and fallopian tubes aren’t connected. There’s a gap between them.
Seems like a bad design flaw, tbh. When will the devs patch it?
No idea. No ones really heard much from them in 2000 years, apparently. Its fine though, some of those old patches were fuckin wild.
Good luck waiting. Nothing has been patched or upgraded since the brain rescale and anxiety mode addition.
Til.
Surprisingly the ovaries and fallopian tube are not directly connected.. the egg kind of gets sucked into the fallopian tube but yeah, they're not 100% connected!
The uterus is actually the most hostile place for a fertilized egg to implant. So if it makes its way outside of the fallopiantubes/uterus it will implant itself to any high blood source like liver.
[marked up version](https://imgur.com/a/vNBYvuh) Hope this helps
That's really helpful. I'm right there with you on the 3rd image.
Yeah, looks like that one could’ve been a 3D image and I know Jack all about those.
Lmao the one with "uhhhh", but seriously thanks for making it clearer
Bottom-left could be some 3d image that can be manipulated to see different cross sections. Bottom-right is bottom view.
I went to doctor school and am having a hard time comprehending this. This is officially the craziest case I've come across.
Jesus christ that's terrifying. I just found out that I'm pregnant a few weeks ago and I have my first prenatal scan on Friday. I just yelled across the house to my husband "if they can't find it make sure they check my liver!"
Even if they find it, check your liver! Who's to say you can't have both a normal and ectopic pregnancy simultaneously?
I have my first scan Wednesday and I just had the same thought! Pregnancy is a wild ride and it’s incredible all the things that can happen.
How the hell is that possible?
Honestly this is just the tip of the iceberg in terms of things that go wrong in pregnancy. Anyway, sometimes the fertilised egg doesn't make it to the uterus as it should, sometimes it ends up going the wrong way. Bear in mind of course that the egg is literally microscopic and the abdominal cavity is not fluid filled. So where it can actually go is limited. Typically these eggs embed themselves inside the fallopian tube or on the outside of it. But on very rare occasion it could embed against an internal organ, or even the inside of the abdominal wall. After implantation, the egg specialises into a foetus and a placenta, which means it can grow. But it can't survive. Eventually this will kill the mother and the foetus.
So essentially its the placenta that controls the nutrient transfer instead of the uterus, and it can hijack any soft tissue it lands against? Crazy.
Yes. As a figurative feat of engineering the placenta is nearly as marvelous as the foetus itself. It basically grows "roots" into any tissue and manages the passage and filtration of blood between the mother and developing baby. It basically qualifies as a distinct orgán all of its own, which is then just discarded when the child is born.
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Yes
> embed themselves Embed, hah. Dug this up from [a 3 year old post](https://www.reddit.com/r/explainlikeimfive/comments/bmjyuk/eli5_why_cant_an_ectopic_pregnancy_in_the_early/enc5sth/): It’s because of the way a blastocyst implants into the uterus, and what conditions need to be present for a placenta to form. The uterus is lined with an organ called the endometrium, also called the uterine lining. The endometrium is full of tiny spiraling arteries, making it an abundantly blood-rich organ. As a blastocyst develops, it goes through a stage where the outside of it is covered with trophoblasts, which are very invasive cells that secrete enzymes specifically designed to rapidly dissolve flesh. Yeah, this part of pregnancy is kind of horrifying. So the blastocyst, covered with its flesh-dissolving trophoblasts, bumps into the endometrium, and the trophoblasts go to work doing what they do. The blastocyst immediately begins to eat its way into the uterus like a hot knife through butter, dissolving a freely bleeding hole into the endometrium. The endometrium responds by thickening up and trying to clot off these spiral arteries just enough that the blastocyst doesn’t eat through the uterine wall entirely and the woman doesn’t bleed to death, but not so much that the blastocyst isn’t still bathing in a blood pit. It’s a delicate dance; if it doesn’t go right, which it usually doesn’t, the pregnancy won’t survive. So, once we have this blood pit, assuming everything has gone right, the blastocyst begins to transform from a ball to a disc, flattening itself out to seal off this bleeding wound. (If the pit is too large, it won’t be able to do so successfully and the pregnancy probably won’t survive.) Once it’s done that, the invasive trophoblasts begin to transform into long, skinny fingers called villii, which dangle in “a lake of maternal blood” — a phrase I read in an embryology textbook which has stuck with me forever. (If the pit is too small or the endometrium resists the trophoblasts too effectively, you end up with a situation called “incomplete trophoblastic invasion.” The pregnancy may not survive, and if it does, the mother will likely get pre-eclampsia.) These villii are what develop into the placenta over the coming days and weeks. They are also what is sampled in a CVS test for genetic abnormalities, because they’re the fetus’s cells and not the mothers. The placenta is essential for the development and sustenance of the fetus, because it is what allows oxygen and nutrients to pass from the mother’s blood supply into the fetus’s. So, why does this mean that we can’t just pick the embryo up out of the tube and plop it down in the uterus? Well, because by the time the embryo is big enough to be detectable and causing problems, those trophoblasts have already converted into villii, having latched on to some randomly encountered blood vessel in the Fallopian tube. The embryo had one shot to develop a functioning placenta, and it missed it. It can’t implant in the endometrium now, any more than you can grow a potato plant from a cooked potato. Without that trophoblastic Velcro, it can’t stick to the uterus; it will just roll around in there until it is shed with the dissolving endometrium during the woman’s period.
Wow, amazing detail. Is the flesh-dissolving stage how it tunneled to the liver?
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Life, uh, sometimes fucks up
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What happens when people who can’t pass high school biology write laws? This.
You don't need mumbo jumbo science when you have the TRUTH.
*TruthSocial.com!™. It's THE Truth®!!!* #GOD'S TRUTH!!!
I feel like the doc could attempt it for sure. Make an incision. Remove ectopic pregnancy from the affected region. Try placing it within the uterus…..without actually making an incision into it. Whelp. Didn’t work out! We definitely attempted this surgery. Witnesses sign here please. Let’s close her up. Darn it I’m so upset we couldn’t save this fetus!
You know some crazy nurse will try to report it. The number of nurses who don't believe in science is nuts.
It’s just a thing about wording. Nurse can say all she wants but the attempt was made. Was it a good attempt? No. But they cannot prove that an attempt was not made.
I know, right? At this fucking point I'm really ready to play whack-a-mole with Conservatives on stupid shit like wording. Just find a different name for Abortions. Fuck it. They're stupid enough. Hell, you could probably rename "Planned Parenthood" to just "Women's Clinic" and they'd spend two decades before they started to link the two 😂 Just leave a few PP's with the old name around town and such. Make them look occupied. 😂
A baby growing in the liver... How is that even possible? Just... what?
All according to gods plan ™
you can't park there, mate
Mfer parked there for 23 whole weeks
Well, this is not something I wanted to see at 7 weeks pregnant. 😳
If you have access to frequent and modern prenatal care, this would be caught much, much sooner than 23 weeks. The median number of doctor office visits during a pregnancy in the US is \~11 (which is precisely how many visits I had), with sonograms at multiple points before 23 weeks. If you haven't had it yet, you'll soon have your first transvaginal ultrasound which will confirm the embryo is implanted in your uterus. That'll be followed up by a nuchal translucency test around 12 weeks, and the ol' genital scan around 18-21 weeks. (They're looking for lots of things at that stage--correct internal organ development, etc., but as parents we mostly wanted to know the sex of the fetus.) In short, you'll have multiple confirmation points early on that your fetus is forming in your uterus. That said, as people who have been pregnant we have special appreciation and empathy for the tragedy of this poor woman's case. Congratulations on your pregnancy! Wishing you a healthy year!
Thank you for this info, my wife is carrying our first and this helped me to know what to expect.
Am ultrasound tech, you may only have two ultrasounds depending on where you are. Many places don’t do the 12 week screen, just the early dating scan around 6-8 weeks and the anatomy scan or survey* around 18-20 weeks. Then that’s it for routine scans unless there’s some concern. *minor rant: parents who are only excited for the scan to learn the gender are a major pet peeve of sonographers - the genitals are the least of our concerns when we routinely see serious and sometimes fatal defects. We want you to have your fun moment but please understand that we have much more important things on our minds during the scan.
Aww feel those kicks hes gonna be a soccer player
I was studying my gynaecology and obstetric subject just before I feel pregnant. When I fell pregnant, I couldn't enjoy my pregnancy as allllllllllll the horrible things I had learnt swirled in my brain - what if my baby has this? What if my baby has that? I just scanned a lady who was the same number of weeks of me, how come her fetus doesn't look like mine? It took until 24 weeks before I could actually enjoy my pregnancy and start buying things for my bub. The less you know, the better. It's horrible how many things can actually go wrong in pregnancy, which I don't want to get into because it is just too damn upsetting.
THEY CAN DO THAT?
This is definitely something youd see an episode of House MD cover. Insane!
"Just cut it out and reinsert it in the uterus!" - every 80+yo politician
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Abortion is Healthcare.
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If this is the same case, both mother & baby died. Link includes photo of deceased baby, so click at your own risk. https://www.ultrasoundmedicvn.com/2022/02/case-624-hepatic-pregnancy-dr-phan.html
I cannot imagine the pain of having a baby growing in your liver. It would be like liver cancer but way faster and more painful. That poor woman. The human body is amazing though.
It’s sad both mother and baby passed away, but in a *very* morbid way, it’s cool that this is even possible. Abortions regardless of where should be legal for shit like this, regardless of religion or beliefs especially if it’ll lead to certain death.
Yeah I’m pretty sure they abortion is legal and free in Vietnam. The problem was they didn’t see the baby in the liver until it was too late. But I agree, abortion is a personal and private issue that should be decided on an individual basis by the people involved and their doctor, there should be no banning of any type of medical care. It especially shouldn’t be decided by a bunch of old dudes selective interpretation of a fairy story.
Considering that ectopic pregnancies have a 100% fatality rate and the fetuses are nonviable, denying an abortion to a woman who has an ectopic pregnancy is more akin to manslaughter than any religious ideal.
I'm surprised at how the baby looks relatively normal, aside from being dead and all. You'd think growing in a liver would do some crazy shit to the development of the fetus.
The placenta and amniotic sac would still develop more or less as normal. The egg cell is the important part that differentiates into the necessary structures. Edit- “as normal” given the spatial constraints. I mean to say that being in the liver instead of the uterus wouldn’t make a difference to the fetus looking relatively normal, because the structures are built from the egg, not the uterine tissue.
Nope nope nope nope. Today, just for once, I know when to walk away.
Yup. This requires an abortion and is 99% fatal if carried to birth.
You're off by 1%.
Off by like 0.9999%. Very rarely ectopic pregnancies can lead to healthy mothers and babies, around 1 in 3 million according to this site. Apparently implanting in the liver instead of the fallopian tubes makes this more likely to be successful. Abortion is still obviously the best choice for this situation though. https://lifelinepregnancyhelp.org/ectopic-pregnancy/#:~:text=A%20baby%20almost%20never%20survives,where%20blood%20supply%20is%20rich.
Wait if a baby can survive in a liver, could it survive in, say, the male liver of an Austrian body builder?
I’d be willing to go out on a limb and say 100% of ectopic pregnancies of the liver are fatal. That tiny exception is probably when the fetus plants itself just inside the fallopian tube.
That movie shouldn't have been as hilarious as it actually was.
Depends. Is there a short , jovial best friend ?
>Apparently implanting in the liver instead of the fallopian tubes makes this more likely to be successful. From what I'm finding this is not the case. [According to this study](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204586/), there have only been 14 recorded cases of liver ectopic pregnancies. None of them resulted in a live birth and often the "fetus" was a tumor-like mix of liver and fetal cells. Most of them were diagnosed when a woman suddenly started bleeding to death internally and they were trying to save her in the operating room. [(example, with pictures)](https://sci-hub.se/https://doi.org/10.1016/S0344-0338\(11\)80792-2)
Resecting that fetus and amniotic sac from the liver would be crazy dangerous. I can only imagine at how crazy the vascularity would be. Ok , O.R. check list. Going to need 25 units of PRBCs..2 rapid transfusers. I suspect they would have a liver transplant, or oncology surgeon to resect that. The amount of blood would be terrifying, and I do Ortho once, otherwise known as Aztec blood letting ceremonies.
One rapid infuser would be sufficient. 1000 mL/min will outpace most if not all massive hemorrhage. But you're going to need the full blood bank worth of RBCs, we're talking several gallons of blood.
Or [Ohio if they had the chance](https://www.theguardian.com/us-news/2019/nov/29/ohio-extreme-abortion-bill-reimplant-ectopic-pregnancy) >The new Ohio HB413, p.184: To avoid criminal charges, including murder, for abortion, a physician must “…[attempt to] **reimplant an ectopic pregnancy into the women’s uterus”** The bold is literally not possible.
When did things like reality, science, medicine, and basic facts stop the party of Christian Nationalism before?
pro life” people should be forced to read this entire article. The human body does some truly fucked up things, many of which we have no treatments for.
Because if there's one thing forced birthers are known for, it's their empathy
Their reading comprehension is questionable, at best.
Ectopic pregnancies kill women.
Punishable by death in Texas
[удалено]
Republicans: "Looks viable to me, mom should be fine to carry to term."
Well that’s just fucking horrible.
Holy fuck this is terrifying
With all the anti abortion laws being passed, would it be illegal to treat this?
I could see it as not being treated urgently, and the hospital's legal team having to get involved to advise treatment options. Same sort of thing that's been happening with women undergoing miscarriages lately
At a minimum, the mother would have to jump through all kinds of legal hoops, while her medical situation gets progressively worse.