Expectant Management of an Abdominal Pregnancy Diagnosed at 18 Weeks: A Case Report

Pablo Silva

doi:10.15406/ogij.2018.09.00295

Abstract

A years old G P patient presented at weeks of gestation with abdominal pain and vomiting A transabdominal ultrasound at admission showed a single live fetus according to gestational age while a transvaginal sonographic examination revealed a normal uterus without an intrauterine gestation Due to the suspicion of an abdominal pregnancy the patient was admitted for further study A magnetic resonance imaging confirms an extrauterine abdominal pregnancy and established placental implantation blood supply and abdominal organs compromise Together with the patient and a multidisciplinary team an expectant management was decided Serial ultrasound assessments were performed to evaluate fetal condition as well as serial MRI to exclude any intra abdominal organ compromise A laparotomy was performed for fetal extraction at weeks of gestation without complications leaving the placenta in situ The patient and newborn had a successful postnatal evolution This report provides evidence that the expectant management of an abdominal pregnancy diagnosed early in pregnancy is feasible

Highlights

The prevalence of an ectopic pregnancy is 1-2%, with approximately 95% of them located in the Fallopian tubes.[1]
An abdominal pregnancy is a very rare form of ectopic pregnancy, which is located in the peritoneal cavity.[2]
A magnetic resonance imaging (MRI) was performed and confirmed an extrauterine intraperitoneal gestational sac located in the maternal right flank with a single live fetus inside

Summary

Introduction

The prevalence of an ectopic pregnancy is 1-2%, with approximately 95% of them located in the Fallopian tubes.[1]. Its clinical symptoms include persistent abdominal pain, nausea, vomiting, painful fetal movements, weight loss, vaginal bleeding, and palpation of an abdominal mass distinct from the uterus.[9,10,11,12] Here, we report a successful expectant management of an abdominal pregnancy diagnosed at 18 weeks of gestation. Due to the suspicion of an abdominal pregnancy, the patient was admitted to our High Risk Pregnancy Unit for further evaluation. A magnetic resonance imaging (MRI) was performed and confirmed an extrauterine intraperitoneal gestational sac located in the maternal right flank with a single live fetus inside. Since the patient requested an expectant management, she was kept admitted in order to perform serial assessment of the maternal and fetal condition, as well as MRIs for further anatomic assessment, including potential placental invasion of intra-abdominal organs (Figure 1). The baby was admitted to Neonatal Intensive Care Unit (NICU) for further observation due to gestational age. Obstet Gynecol Int J. 2018;9(1):[13,14,15,16]

Findings

Discussion

Conclusion