Conservative Management and Planned Surgery for Periviable Advanced Extrauterine Abdominal Pregnancy with Favorable Outcome: Report of Two Cases

Abstract

Advanced abdominal pregnancy is an extremely rare condition that poses diagnostic and management challenges. A high index of suspicion and careful assessment of the patient's symptoms, supplemented with obstetric ultrasound, and magnetic resonance imaging, are crucial for timely diagnosis and management to prevent life-threatening complications. The presence of periviable fetuses in advanced abdominal pregnancies increases the challenge to achieve a balance between maternal and fetal benefits and risks. Early diagnosis and management decisions via a multidisciplinary approach and planned delivery are of paramount importance to minimize complications and achieve favorable maternal and fetal outcomes. Even in the setting of oligohydramnios and suspected preterm premature rupture of membranes, in-patient conservative management and an individualized planned surgical approach that includes removing or leaving the placenta in place are appropriate for managing the periviable abdominal pregnancy.

Advanced extra-uterine pregnancy: A review of the literature

“…Because of the atypical presentations, differentiation from abruptio placentae, placenta previa, uterine rupture, post-maturity, ovarian cysts and uterine myoma is challenging. [21] Recurrent abdominal pains in a patient with a history of infertility, tubal surgery or past history of ectopic pregnancies may signal an abdominal pregnancy. [22] Table 1 shows a survey of signs and symptoms as reported in a few studies.…”

“…These authors suggest such management because it is not possible to predict placental separation with subsequent major intra-abdominal bleeding. [21,43] Recent reports appear to take the middle path and adopt an individualised approach. [44,45] If the pregnancy is <24 weeks, immediate operative intervention is indicated because of the high risk of maternal morbidity and mortality with poor fetal prognosis if the pregnancy is continued.…”