Delayed diagnosis and management of second trimester abdominal pregnancy

Abstract

Second trimester abdominal ectopic pregnancies are rare and life threatening. Early diagnosis and treatment are paramount in reducing maternal morbidity and mortality. We describe an unusually late diagnosis of abdominal pregnancy despite multiple ultrasounds beginning in early pregnancy. A 28-year-old G2P1001 sought pregnancy termination at 22 weeks’ gestation after fetal anomalies were noted on an 18-week ultrasound during evaluation for elevated maternal serum alfa-fetoprotein. Due to abortion restrictions in her home state, she travelled over 500 miles for abortion care. During dilation and evacuation, suspected uterine perforation led to the finding of a previously undiagnosed abdominal pregnancy. At laparotomy, she underwent left salpingo-oophorectomy and removal of abdominal pregnancy and placenta. A multidisciplinary team approach was paramount in optimising the patient’s outcome. Abortion restrictions requiring travel away from the patient’s home community interrupted her continuity of care and created additional hardships, complicating management of an unexpected, rare and life-threatening condition.

Rare Ectopic Pregnancies – A Literature Review for the Period 2007 – 2019 on Locations Outside the Uterus and Fallopian Tubes

“…According to some authors, the extent of placental adhesion can be determined preoperatively using MRI [121]. Provided that placental blood supply can be safely disrupted, then resection of the placenta is recommended [37,40,57]. Otherwise the placenta can be left in situ, after the umbilical cord and fetal membranes have been removed [4].…”

“…Das Ausmaß der plazentaren Adhäsion kann nach Angaben einiger Autoren präoperativ durch MRT festgestellt werden 121 . Unter der Voraussetzung, dass die plazentare Blutversorgung erfolgreich unterbunden werden kann, wurde eine Resektion der Plazenta empfohlen 37 , 40 , 57 . Andernfalls kann die Plazenta in situ belassen werden, nachdem die Nabelschnur und die Eihäute reseziert wurden 4 .…”

A Rare Coincidence—a Second Trimester Ectopic Pregnancy Following Early Medical Abortion: a Case Report

“…From a secondary care point of view, the diagnosis of a second trimester pregnancy is also difficult, and there have been a number of pregnancies diagnosed as intrauterine when in fact the pregnancy location is extra-uterine [ 17 , 18 ]. The size of the gestational sac and presence of a foetus can cause uncertainty and difficulty in the diagnosis and thus shows the importance of a trained sonographer and a consistent, systematic approach to ultrasound in early pregnancy.…”

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

“…In a review of 225 case reports, mean blood loss was 1450 mL (range 50-7500 mL) and 25% of women required blood transfusion [16]. Among the options available for preoperative preparation are arterial embolization, ureteral catheters insertion, bowel preparation, blood bank assistance for massive transfusion protocols, and a multidisciplinary surgical team available [20,25].…”