Secondary abdominal pregnancy and its associated diagnostic and operative dilemma: three case reports

Abstract

IntroductionAbdominal pregnancy is extremely rare and has historically been defined as an implantation in the peritoneal cavity, exclusive of tubal, ovarian or intraligamentary pregnancy.Case presentationsThree cases are reported. All came from a lower middle-income group and all of them were subjected to surgery. The first patient was a 30-year-old woman, who was pregnant for the fourth time, who presented at 16 weeks with an abdominal pregnancy. She was admitted with constant abdominal pain and retention of urine. She was hemodynamically stable and was administered a pre-operative intramuscular injection of methotrexate. During laparotomy she had only minor blood loss, the major part of the placenta was removed easily and she did not require any blood transfusion. Serum beta human chorionic gonadotrophin values and ultrasound follow-up revealed a normal study four weeks after surgery. The second patient was a 26-year-old woman, pregnant for the third time, admitted at 14 weeks with an abdominal pregnancy with hemoperitoneum, and the third patient was a 24-year-old woman, pregnant for the first time, who presented at 36 weeks gestation. She was only diagnosed as having an abdominal pregnancy during surgery, experienced excessive blood loss and required a longer hospital stay.ConclusionsWe hypothesize that treatment with pre-operative systemic methotrexate with subsequent laparotomy for removal of the fetus and placenta may minimize potential blood loss, and would be a reasonable approach in the care of a patient with an abdominal pregnancy with placental implantation to the abdominal viscera and blood vessels. This treatment option should be considered in the management of this potentially life-threatening condition. During surgery, if the placenta is attached to vital organs it should be left behind. Early diagnosis can help in reducing associated maternal morbidity and mortality.

Preoperative Methotrexate in Broad-Ligament Pregnancy: Is There a Role?

“…8 The diagnosis is usually made in the first and second trimesters, or, occasionally, in the third trimester 7,8 on US imaging. Approximately 50% of diagnoses are missed on ultrasound but MRI and computed tomography provide more accurate information when the diagnosis is in doubt.…”

“…Approximately 50% of diagnoses are missed on ultrasound but MRI and computed tomography provide more accurate information when the diagnosis is in doubt. 8 Treatment of broad-ligament pregnancy conventionally involves immediate laparotomy with excision of the fetus. As broad-ligament pregnancy is a life-threatening condition, expectant management carries a risk of sudden lifethreatening intraabdominal bleeding and a generally poor fetal prognosis.…”

Intraligamentary Extrauterine Pregnancy Delivered at Term: A Case Report and Review of Literature

“…Bleeding from the placenta implantation site is the most life threatening complication encountered at laparotomy and the decision to remove the placenta or not can be a determining factor for survival of the woman. It is recommended to leave the placenta in situ if removal is life threatening and follow up the patient with post-operative Methotrexate therapy, hCG estimation and ultrasonography 12 . Chemoembolization through lateral sacral artery has also been advocated 13 .…”

Term Live Secondary Abdominal Pregnancy: A Case Report

“…The term excludes pregnancies implanted in the fallopian tube, ovary, or broad ligament (1,2). In secondary abdominal pregnancy, after implantation in the uterine cavity or fallopian tubes, the foetus is expelled through the defect in the implantation site into the peritoneal cavity, where it continues to grow (3).…”