Ectopic abdominal pregnancy due to uterine perforation after an attempt to terminate pregnancy: a case presentation

Abstract

Secondary abdominal ectopic pregnancy is rare in clinical practice, but may lead to an increased maternal mortality. We present the case of a patient with an abdominal pregnancy secondary to a uterine perforation caused by a voluntary attempt to interrupt pregnancy that presented with nine weeks of abdominal pain and minimal vaginal bleeding which was mistakenly diagnosed as acute pelvic inflammatory disease, urinary tract infection, and post-abortion products of conception. Finally, the abdominal ultrasound test found an abdominal ectopic pregnancy. An exploratory laparotomy was performed and the fetus and placenta were removed without difficulties with a favorable postoperative course. It was concluded that uterine perforation during curettage of the cavity went unnoticed, leading to secondary abdominal implantation of pregnancy with a inconclusive clinical presentation, where ultrasound plays a fundamental diagnostic role. Laparotomy is indicated in most of these cases.

An unexpected case of ectopic pregnancy of the mesosalpinx

“…10,11 Other possible causes for secondary abdominal pregnancies include fistulous track formation following in vitro fertilization procedures or previous surgery, and undiagnosed uterine perforation during embryo transfer or termination of pregnancy. 12,13 Our presented patient likely had a primary abdominal ectopic pregnancy as she presented early in first trimester and was noted during laparoscopy to have normal reproductive organ structures with no pelvic adhesions and the ruptured conceptus was noted to be implanted in the mesosalpinx completely separate from the uterus and tubes.…”

Advanced secondary abdominal pregnancy: a case report

“…Secondary abdominal pregnancy commonly occurs as a result of a tubal pregnancy that detaches into the abdominal cavity (tubal abortion) or a cornual/ caesarean scar ectopic that ruptures into the abdominal cavity [7]. Again, more exceptional situations, such as iatrogenic uterine perforation following a pregnancy termination, may also occur [8]. The presence of a fistula tract along the fundus of the uterus is highly suggestive of prior instrumentation, but as demonstrated by Rossier et al, obtaining a full disclosure about induced abortions, especially from women in LMICs of poor socioeconomic backgrounds, is infrequent [9], perhaps due to very high levels of stigma [10].…”

Reflexiones acerca de las políticas para la atención del embarazo ectópico

“…(4) El embarazo es eutópico o intrauterino cuando el huevo anida y se desarrolla en el endometrio de revestimiento de la cavidad uterina, cuando este proceso se genera en cualquier otra parte anatómica puede decirse es un embarazo ectópico. (4)(5)(6)(7)(8)13) Según Hernández Núñez et al, (14) esta patología del embarazo tienen una frecuencia de incidencia del 0,8 % al 2,0 %. En el contexto de Reino Unido, Pommer et al (15) señalan que es la primera causa de mortalidad materna del primer trimestre (0,35/1000).…”