Successful Management of Abdominal Pregnancy: Two Case Reports

Abstract

Abdominal pregnancy is a rare, life-threatening condition defined as pregnancy in the peritoneal cavity exclusive of tubal, ovarian, or intraligamentary locations. It can be primarily located in the peritoneal cavity or secondary to a ruptured ectopic pregnancy or tubal abortion. We present two cases of abdominal pregnancy, one primary and another secondary, both diagnosed and successfully managed in our institution. The first patient, a para 2 at 14 weeks gestation, presented with abdominal pain, distension, and dizziness, which had started four days prior. The initial radiological scan reported an intrauterine pregnancy with ascites, but a bedside ultrasound revealed an empty uterus and a viable pregnancy located in the Pouch of Douglas (POD). This was a secondary abdominal pregnancy managed successfully by laparotomy. The second patient, a para 3 + 4 miscarriages with seven weeks amenorrhea was admitted with an initial diagnosis of pregnancy of unknown location. She had a beta human chorionic gonadotropin level of 14 444 mIU/mL. Diagnostic laparoscopy revealed a hemoperitoneum, bulky uterus, normal looking right and left adnexa, and a dense irregular bleeding tissue of around 3 × 4 cm firmly attached to the POD. The histopathology report of the tissue retrieved from the POD confirmed products of conception. This case report supports the importance of awareness and high clinical suspicion for such a life-threatening condition to avoid maternal morbidity and mortality. To the best of our knowledge, no previous cases of abdominal pregnancy have been reported in the UAE to date.