Management of Abdominal Pregnancy

Abstract

<h3>Study Objective</h3> Abdominal pregnancy (AP) accounts for 1-2% of all extrauterine gestations and is associated with 80% perinatal mortality. Despite advancements in antenatal care and imaging, the standard management protocol for AP is not yet established. In this series, we report two cases of interval surgical management of AP following medical treatment. <h3>Design</h3> Case Series. <h3>Setting</h3> Academic institution. <h3>Patients or Participants</h3> Two patients. <h3>Interventions</h3> Pregnancy interruption medically and subsequent surgical removal. <h3>Measurements and Main Results</h3> Case 1 33-year-old P0 with history of uterine fibroids presents with abdominal pain. Imaging demonstrated a 12-week fetus in the rectouterine space. Fetal intracardiac KCl and intra-sac methotrexate were administered with a plan for close outpatient follow up. She re-presented with severe sepsis and underwent emergent surgery for pelvic abscesses. Case 2 37-year-old P0010 with a prior abdominal myomectomy at 13-weeks' gestation presented for scheduled antenatal ultrasound. AP was identified on the posterior uterine wall. Fetal intracranial digoxin was administered and the patient was followed with serial beta-human chorionic gonadotropin (bHCG). bHCG remained persistently elevated for 6 months and underwent robotic-assisted laparoscopic removal of products of conception. <h3>Conclusion</h3> Abdominal pregnancy is a rare and complex entity which encompasses a broad spectrum of clinical presentations. There is a range of methods described to manage AP with the majority of cases managed by primary surgical intervention. In this series, our cases of AP were initially managed medically, with planned interval surgery in order to decrease morbidity of primary surgical intervention. Possible complications related to AP include intra-abdominal hemorrhage, sepsis, and persistent products of conception. Currently, a consensus regarding the management of AP and related complications does not exist. We recommend a high clinical suspicion, multidisciplinary approach, and strict follow-up in order to optimize maternal outcomes.