Early Abdominal Ectopic Pregnancies: A Systematic Review of the Literature

Abstract

Objective: To define abdominal ectopic pregnancy outcomes by both location and treatment. Methods: Literature review of abdominal pregnancies from 1965 to August of 2009. Ectopic pregnancy exclusions were interstitial, tubal, cervical, ovarian, or those beyond 20 weeks at diagnosis/treatment. Results: There were 511 cases identified with 225 meeting the inclusion criteria. There were 7 maternal deaths (3.0%) with 18 (8%) of the early abdominal ectopic pregnancies occurring with an intrauterine device in place. Mean gestational age at the time of treatment was 10 weeks 0 days and mean maternal age was 29.7 years. The average blood loss associated with treatment was 1,450 ml. The top three sites of early abdominal ectopic pregnancies were pouches around the uterus (24.3%), serosal surface of the uterus and tubes (23.9%), and multiple sites (12.8%). Primary surgical management was performed in 208 cases (87.8%). Nonsurgical adjuvant or primary therapy included intramuscular methotrexate, intralesional methotrexate, intracardiac KCl, and artery embolization. Conclusion: Abdominal pregnancies should be considered in all patients until an intrauterine location can be confirmed. Understanding treatment options by pregnancy location may be helpful in the management of this potentially life-threatening condition.

Primary Abdominal Pregnancy in the Uterosacral Ligament with Haemoperitoneum: A Near Miss

“…Pregnant women with advanced maternal age may be at an increased risk of extra-tubal gestations [2]. The mortality rate associated with early abdominal pregnancies can be as high as 30/1000 [3].…”

“…Risk factors for abdominal pregnancy include tubal damage pelvic inflammatory disease, endometriosis, intrauterine insemination, assisted reproductive techniques and use of intrauterine contraceptive devices [3,6,7]. Endometriotic spots represent obstetrics and Gynaecology…”

“…One-fourth of them were located in the pouches surrounding the uterus (majority in the pouch of Douglas). Abdominal pregnancy was diagnosed at 9 weeks of gestation on an average, at a mean serum Beta hCG level of 15670 mIU/mL [3]. The most frequent complaint is abdominal pain [9] and other symptoms relate to the site of placental attachment.…”

“…Treatment modalities consist of surgery, parenteral/intraamniotic methotrexate, intracardiac potassium chloride, embolization and combinations of these [3,15]. Management depends on the gestational age, site of placental attachment, patient's condition and clinician's experience.…”

“…The Beta hCG levels do not correlate with the success of medical management. Nearly 90% of cases of early abdominal pregnancies are treated by primary surgery, because most present with haemoperitoneum and almost half of those who are treated medically subsequently need to undergo operative procedures [3].…”