Abdominal Ectopic Pregnancy Research Articles

Ultrasonic diagnosis of hepatic ectopic pregnancy: a case report

Hepatic ectopic pregnancy is an extremely rare ectopic pregnancy. Ectopic pregnancy is one of the reasons for acute abdominal pain. Ectopic pregnancy refers to the growth and development of zygotes outside the uterine cavity, and tubal pregnancy is the most common. Abdominal ectopic pregnancy is very rare, accounting for only 1.3% of all ectopic pregnancy including small intestine and large intestine, sigmoid colon, omentum, liver, diaphragm, pancreas, peritoneum and spleen [1], of which the incidence of hepatic ectopic pregnancy is about 1:15,000 per inner uterus pregnancy [2]. The present report describes the case of a 36-year-old woman who presented with continuous brown vaginal secretions after 57 days of amenorrhea. The patient was initially diagnosed with liver ectopic pregnancy by abdominal ultrasound and this was confirmed by laparoscopic exploration. The pathological examination revealed a pregnancy material in the liver tissue. The patient made good progress post-surgery, with serum levels returning to normal during a follow-up examination 1 month later. Overall, ultrasound and β-HCG levels are crucial in diagnosing ectopic pregnancy before patients show clinically consistent symptoms.

Unusual Location: Omental Ectopic Pregnancy Killing Me Slowly

Objective: Omentum pregnancy is an ectopic pregnancy in the abdominal cavity. The event has high morbidity and mortality. The purpose of this case is to present a rare case of abdominal ectopic pregnancy that occurred in a young woman.
 Methods: Case report.
 Results: A 22-year-old woman at 16 weeks gestation presented with abdominal pain and clinical shock. Examination results revealed pregnancy outside the womb, with an estimated fetal weight of 193 grams and positive heart activity. The patient underwent laparotomy surgery, revealing that the pregnancy had occurred in the omentum organ with placental attachment.
 Conclusion: In this case, emergency management began with the patient's reception in the emergency department, followed by laparotomy exploration. After a meticulous surgery, the pregnancy's location was identified in the omentum, and the evacuation of pregnancy products was performed. The patient received treatment for several days until being discharged home. Early diagnosis and interprofessional management are crucial if similar conditions are suspected in the future to prevent morbidity.
 Keywords: abdominal cavity, ectopic pregnancy, omental pregnancy

Case report of ectopic pregnancy on transverse colon

Abdominal ectopic pregnancy is a rare form of ectopic pregnancy, and there are a few cases of colonic implantation reported in the literature. In this report, we describe a unique instance of transverse colonic large hematocele associated with degressive ectopic pregnancy. Patient concerns: A 30–year–old female patient suffered abdominal pain and digestive disorders and did not report any gynecological diseases. The only indicator to diagnose gestative condition was beta-HCG, which increased slightly from 415IU/L to 435IU/L after 2 weeks. Transvaginal ultrasonography shows no evidence of a gestational mass inside the uterus or in the cul-de-sac, which is a frequent site of ectopic pregnancy. But abdominal CT with contrast injection revealed a hyperdense mass measuring 50´53´101mm along the edge of the right colon. A diagnosis of abdominal pregnancy was suspected. Thus, the patient underwent explanatory laparoscopy to confirm the diagnosis and for the treatment. Pathological examination confirms the diagnosis of transverse colonic ectopic pregnancy. After a few days of uncomplicated recovery, the patient was cleared to return home. On the first day following surgery, the beta-HCG results decreased to 112IU/L, and additional testing produced negative results. Conclusion: Ectopic pregnancy may be implanted anywhere in the abdominal cavity even on the transverse colon. When diagnosing a female patient of reproductive age with an inexplicable rise or even low blood BetaHCG level, clinicians must consider the potential of abdominal ectopic pregnancy.

Successful Outcome of a Heterotopic Pregnancy: A Case Report

Heterotopic pregnancy refers to the presence of simultaneous pregnancies at two different implantation sites. We present an unusual case of term heterotopic pregnancy, the ectopic pregnancy being abdominal implantation. The co-existence of spontaneous full term intra-uterine with advanced abdominal ectopic pregnancy and both viable babies without any residual effect or congenital anomalies is one of the rarest forms of heterotopic pregnancy. Other than Ultrasound, increased HCG, or alpha feto protein, sophisticated modern technology like MRI or CT’s Scan absolutely needed for proper diagnosis, placental localization and vascularization to prevent intra-operative catastrophies. J Bangladesh Coll Phys Surg 2023; 41(4): 338-341

Abdominal Ectopic Gestation In The Second Trimester At A District Hospital: A Rare Case

Introduction: Abdominal ectopic pregnancies are uncommon forms of ectopic pregnancies. They might be unnoticed until late in pregnancy and are associated with an increased risk of maternal complications and mortality. This is a case report of an abdominal ectopic gestation diagnosed at the first visit to a district hospital in Ghana and how it was managed in a low-resource setting.
 Case Presentation: A 28-year-old gravida 4 parity 3, presented with 4 months history of amenorrhoea associated with recurrent bleeding per vaginum. Ultrasound showed a slightly bulky uterus with very scanty echogenic material within the endometrial cavity. There was however a right adnexal gestational sac with a live foetus at 19 weeks + 4 days and no free fluid was seen in the pouch of Douglas. The patient was counselled and prepared for an emergency exploratory laparotomy and intraoperative findings showed normal size uterus of about 8 weeks in size with an unruptured right adnexae gestation. The gestational sac was in the region of the right ovary which could not be visualised and attached to the uterus via the ovarian ligament with a normal-looking right tube. Post-operative recovery was uneventful and she was discharged three days later. 
 Conclusion: Abdominal ectopic gestation can pose a diagnostic challenge, particularly in low-resource settings. There is a need for clinicians to have a high index of suspicion and provide timely surgical intervention necessary to reduce complications and mortality associated with the condition.

A RUPTURED NONCOMMUNICATING RUDIMENTARY HORN PREGNANCY: A CASE REPORT

Pregnancy in the rudimentary horn is rare and carries grave consequences for the mother. Here, we report a case of 26-year G3P2 with 17 weeks gestation who presented with lower abdominal pain. Ultrasound showed hemoperitoneum with suspicion of abdominal ectopic pregnancy. Intraoperatively the diagnosis of ruptured left rudimentary horn pregnancy was made. The fetus and placenta were removed followed by excision of the horn with ipsilateral salpingectomy done. Keywords: Ruptured rudimentary horn pregnancy, Unicornuate uterus, uterine anomalies

Fertility-preservation laparoscopic management of an intact broad ligament abdominal ectopic pregnancy: a case report

This study reports a rare case of broad ligament abdominal ectopic pregnancy (EP). Interventions included preoperative transabdominal and transvaginal ultrasonography and operative laparoscopy. Successful extraction of the EP, followed by suturing of the mesosalpinx, was performed. Laparoscopic fertility-preservation treatment of broad ligament EP is valuable for women during the childbearing period.

Primary omental pregnancy in a subseptate uterus: A novel case report and literature review

Introduction and Importance: Ectopic pregnancy is defined as a pregnancy in which the fertilized ovum implants itself in a location other than the uterine endometrium. Abdominal ectopic pregnancies involve the implantation and development of the embryo within the peritoneal cavity. Primary omental pregnancies are the rarest form of abdominal pregnancy and possibly the rarest extrauterine gestation. Case Presentation: We report the first case of a primary omental pregnancy in a subseptate uterus in literature. Our patient, a 33-year-old female, G8P4+3, presented with nausea, severe abdominal pain, and vaginal spotting at 6 weeks’ gestational age. She had mild tenderness below the umbilicus, with positive cervical and right adnexal tenderness. 2D-ultrasound revealed a subseptate uterus, normal ovaries and fallopian tubes, absence of a gestational sac, and a 4×3×2.5 cm mass in the right adnexa. A mini-laparotomy was performed due to suspicion of ruptured tubal pregnancy, revealing a primary omental pregnancy which was managed via partial omentectomy. Clinical Discussion: Ectopic pregnancies have ambiguous presentations, however correct diagnosis and management is crucial to prevent complications. A high index of suspicion must be exercised to make an accurate diagnosis of primary omental pregnancy. A subseptate uterus is a subtype of the most common uterine anomaly and should be investigated via 3D-ultrasound and magnetic resonance imaging as it causes increased risk of primary omental implantation. Conclusion: Correct identification of subseptate or septate uteri is vital. Greater research is needed to elucidate the association between septate or subseptate uteri and ectopic pregnancy, particularly primary omental pregnancy.

A Rare Case Report: An Abdominal Ectopic Pregnancy in Subfertile Patient Managed with Minimal Invasive Surgery

A Rare Case Report: An Abdominal Ectopic Pregnancy in Subfertile Patient Managed with Minimal Invasive Surgery

Abdominal Ectopic Pregnancy with a Living Fetus in Multiparas at 31 Weeks of Gestational age

Abdominal Ectopic Pregnancy with a Living Fetus in Multiparas at 31 Weeks of Gestational age

Medical management of hepatic ectopic pregnancy with systemic methotrexate, MRI and serial HCG monitoring

Introduction: Hepatic ectopic pregnancies remain a diagnostic challenge which contributes to high morbidity. Little is known about the efficacy of medical management of hepatic ectopic pregnancies. As early pregnancy diagnosis continues to improve, more abdominal ectopic pregnancies will be identified before a complication occurs and patients may be candidates for less invasive management approaches. Case Report: A reproductive age G2P0010 presented with pleuritic RUQ pain and was ultimately diagnosed with a hepatic ectopic pregnancy. Given the location of the pregnancy and the difficulty accessing it from both an interventional radiology and surgical perspective, inpatient medical management with methotrexate was pursued. A multidisciplinary team including gynecology, interventional radiology, hepatobiliary surgery, and trauma surgery all participated in perioperative planning in case of an acute deterioration. The patient remained hemodynamically stable and exhibited an appropriate response to methotrexate therapy using the multi-dose regimen. Persistent radiographic changes were still evident in the liver six months later despite resolution of the human chorionic gonadotropic (HCG) values. Conclusion: This case represents a conservative approach to a complex diagnosis and should inform future clinicians expeditious administration of methotrexate therapy and careful consideration of interval imaging for treatment response.

Abdominal Ectopic Pregnancy: Challenging Obstetrical Paradox in Series of Three Cases

Abdominal Ectopic Pregnancy (AEP), a rare life-threatening obstetrical complication, is defined as ectopic implantation within the peritoneal cavity outside the uterus, tubes, ovaries, or intra-ligamentous locations. A series of three rare cases of early AEP is presented: (First case: a 32-year-old, gravida 2, para 1; Second case: a 31-year-old, gravida 3, para 2; and Third case: a 39-year-old gravida 4, para 2). All the cases were of early (<20 weeks) primary AEP and they all presented with acute abdomen, unstable vitals, and haemoperitoneum. The first case had omental implantation with a gestational sac of (3×3) cm and was diagnosed by strong clinical suspicion with intraoperative confirmation for the same, whereas the second and third cases had implantation on Pouch of Douglas (POD) and sigmoid colon respectively; and was diagnosed by sonography with intraoperative confirmation during laparotomy. All three cases were successfully managed by a multidisciplinary team approach, blood transfusions, and emergency laparotomy with complete removal of the placenta. They had a good postoperative recovery. The reports of histopathology of tissues retrieved peroperatively from the implantation sites showed chorionic villi which confirmed the product of conceptions. Presentation of this case series provides an opportunity to illustrate a rare variant of ectopic pregnancy with a challenging obstetric dilemma and to discuss the importance of strong clinical suspicion for such a grave maternal condition, on the part of the attending obstetrician, to make an early diagnosis and prompt treatment, so that maternal morbidity and mortality can be avoided.

Abdominal ectopic pregnancy at 23 weeks prime pregnant. Case report

El embarazo ectópico abdominal es una patología poco frecuente, la cual consiste en un embarazo con implantación dentro de la cavidad abdominal y fuera del útero y sus anexos; siendo el menos frecuente de los embarazos ectópicos, y representando el 1 % de los casos. Sin embargo, cuando se presenta, la tasa de mortalidad materno-fetal es alta, por lo que representa una urgencia médica con complicaciones graves como hemorragia obstétrica. El diagnóstico requiere un alto grado de sospecha, debido a que el sangrado menstrual regular puede estar presente. Se presenta el caso de una paciente primigestante con embarazo ectópico abdominal en segundo trimestre, con manejo definitivo quirúrgico y posterior evolución materna favorable al postquirúrgico, sin embargo, con resultado perinatal adverso para el recién nacido. La importancia de este caso radica en su diagnóstico oportuno, por el cual se logró evitar complicaciones que pusieran en riesgo la vida de la paciente.

ECTOPIC ABDOMINAL PREGNANCIES: ABOUT 2 CASES

The abdominal location is even more exceptional and presents less than 1% ofectopic pregnancies. We report and descript of the emergency approach that we used for management of an abdominal pregnancy for two patients who they are presented to our unit. For the two case the main symptom was the acute pelvic pain on the notion of amenorrhea, after complementary examen and given the urgency we proceeded, to an exploratory laparotomy that found an abdominal ectopic pregnancy. The issue for the two patients had an uneventful recovery and they were discharged the next few days. These cases are presented to highlight the dilemma associated with diagnosis and management of abdominal pregnancy with a review of literature.

Non-communicating rudimentary horn pregnancy presenting as sudden unexpected maternal death: an autopsy diagnosis.

Pregnancy on a rudimentary uterine horn is a rare condition that can lead to a catastrophic outcome when it ruptures. The majority of cases are diagnosed late, after the rupture has occurred. We present the case of a 29-year-old female G2 P1 who complained of abdominal pain. She consulted a medical practitioner who prescribed her analgesics. In the next day, she was found dead in her bedroom. The pregnancy was undiagnosed as she was not aware that she was in a gravid state. At autopsy, there was massive haemoperitoneum and a 24-week gestation foetus lying outside the uterus. The uterus revealed an anomaly in keeping with a non- communicating rudimentary horn. Forensic pathologists do encounter undiagnosed ectopic pregnancies in practice. However, abdominal ectopic pregnancy with a uterine anomaly remains uncommon. These cases are often associated with a high maternal and foetal mortality.

CESAREAN SCAR ECTOPIC PREGNANCY- AN ENIGMA

Cesarean section scar ectopic is a rarest form of abdominal ectopic pregnancy. It has a relation with increasing numbers of cesarean delivery and has an incidence of about 0.09% of all pregnancies nowadays. In this case a 27 years old woman had presented with amenorrhea, pain in lower abdomen and per vaginal bloody discharge. Her serum beta-HCG level was elevated. She was haemodynamically stable. No abnormalities were detected per abdominally, only bloody discharge was present on per speculum examination. Radiological ndings of G-sac like structure embedded in previous lower segment caesarean scar of uterus suggested of caesarean scar ectopic. Color Doppler had shown blood ow in scar decient area. In this case medical management with systemic methotrexate failed. Eventually surgical resection of the G-Sac with scar tissue was done by laparotomy followed by repair of the wound. Thus early diagnosis and management prevented further complications like uterine rupture, hysterectomy and even maternal death

Ruptured primary abdominal ectopic pregnancy- management in a resource-low setting

Abdominal ectopic pregnancy is a rare form of ectopic pregnancy, which has a high mortality. Herein, we present a case of ruptured primary abdominal ectopic pregnancy implanted on sigmoid mesocolon in a 36-year-old woman. This case report highlights the challenges faced by obstetrician-gynecologist in the diagnosis and management of abdominal ectopic pregnancy in a resource-low setting.

Left Sided Abdominal Ectopic Pregnancy with Placenta in Rudimentary Horn-Complicated With Acute Renal Failure: A Case Report

Though unicornuate uterus with rudimentary horn is a rare Mullerian duct malformation, it is marked with frequent undesired gynaecological and obstetrical complications. Rupture of gravid horn results in maternal and foetal morbidity and mortality. A case of rudimentary horn pregnancy at 15 ± 4 weeks was reported here, with acute renal failure in the postoperative period. The favorable maternal outcome was only ensured after extensive hemodialysis sessions apart from appropriate intensive care management.

A unique case of coexisting intrauterine and abdominal pregnancy which progress to term with a positive birth outcome

BackgroundThe term heterotopic pregnancy is defined as a uterine pregnancy coexisting with a second pregnancy in an extrauterine location. Spontaneous, full-term heterotopic pregnancy with alive birth is very rare. The diagnosis and management of such exceptionally unique case is difficult. When the patient presented with an advanced labor with no antenatal care follow up and with no risk factors is even more challenging for poorly equipped facilities like ours.Case presentationA 25 years old gravida 3, para 2 (both are alive) mother presented to the labor and delivery ward of Bele Primary Hospital, Southern Ethiopia with the complaint of pushing down pain of 18 h duration. Immediately after arrival, she gave birth to a 3300gm female neonate spontaneously. After delivery, an abdominal mass was recognized and manual exploration of the uterus was done to look for the presence of after coming second twin but the uterus was empty. On ultrasound examination, there was an alive fetus in transverse lie outside the uterus. With the impression of 2nd twin in a separate horn of bicornuate uterus and to rule out abdominal pregnancy, laparotomy was done. On laparotomy, there was abdominal pregnancy in the Pouch of Douglas with an intact amniotic sac. The sac was attached with the left broad ligament, left ovary, small bowel mesentery, and posterior wall of the uterus. The sac opened, a 1600gm alive female neonate with features of fetal growth restriction and left club foot was delivered. The placenta was detached spontaneously and removed without any complication.ConclusionsThe coexistence of spontaneous full-term intrauterine with advanced abdominal ectopic pregnancy is one of the rarest forms of heterotopic pregnancy. Every health professional should bear in mind that intrauterine and extrauterine pregnancy may happen simultaneously and it can progress to term without any symptoms. Ultrasound is the diagnostic method of choice but the existence of an intra-uterine pregnancy cannot rule out ectopic pregnancy. The life-threatening complication of abdominal ectopic pregnancy is bleeding from the detached placental site. Therefore, the decision to remove the placenta should be individualized.

Maternal Near-Miss and Maternal Death Associated with Abdominal Ectopic Pregnancy: Case Series from a Tertiary Hospital in Southern Ethiopia

Maternal Near-Miss and Maternal Death Associated with Abdominal Ectopic Pregnancy: Case Series from a Tertiary Hospital in Southern Ethiopia