Late Abdominal Pregnancies (≥20 Weeks Gestation): A Review from 1965 to 2012

Abstract

Background: Information about the diagnosis and management of late abdominal pregnancies (≥20 weeks gestation) is limited to case reports and small case series. Methods: We performed a literature review of abdominal pregnancies ≥20 weeks gestation from 1965 to November 2012. Excluded were abdominal ectopic pregnancies that did not primarily implant in the peritoneal cavity, including tubal, ovarian, and intraligamentary pregnancies, and those prior to 20 weeks gestation. Results: The 31 cases identified were at 30.4 ± 7.4 weeks at diagnosis and 33 ± 8.3 weeks at delivery. The most common sites of placental implantation were uterus or adnexa (47.8%), bowel (30%), and the potential spaces surrounding the uterus (8.7%). There were 5 cases of an intra-abdominal abscess in the 14 patients in whom the placenta had been left in situ. Maternal outcomes were documented in 26 cases with 7 deaths; 27 fetal outcomes were documented in 22 cases with 3 fetal deaths (13.6%). Conclusion: An abdominal ectopic pregnancy is an uncommon but serious event and should be considered in all patients until intrauterine gestation is confirmed. Management should be undertaken by an experienced surgical team in a tertiary care facility.

Unexpected Advanced Abdominal Pregnancy from a Placenta Previa Suspicion: A Case Report

“…Administration of methotrexate or expectant management can be applied as potential follow-through management when it comes to a decision to leave the placenta. Administration of methotrexate can accelerate the destruction of the placental tissue; however, it can increase the risk of infection since the speed of the placental tissue destruction by methotrexate can lead to tissues necrosis, permitting infectious microorganisms to grow [2].…”

“…Conceptual implantation in advanced abdominal pregnancy can take place in the omentum, ligamentum latum, abdominal organs, or blood vessels located in the abdomen and pelvis. The estimated occurrence of advanced abdominal pregnancy with live birth is about 1:10,000 to 1:30,000 from all pregnancies and 1% from ectopic pregnancy [1][2][3]. Advanced abdominal pregnancy occurs as a result of fertilization taking place in the abdominal cavity, tubal rupture, and tubal abortion.…”

“…Perinatal deaths occur in 5-25% of the total AAP cases which are mainly caused by prematurity, impaired fetal growth, and bleeding. Nowadays, with improved neonatal management, 70-80% of babies with gestational age older than 30 weeks can survive [1,2].…”

An abdominal ectopic pregnancy following a frozen-thawed ART cycle: a case report and review of the literature

“…Among the EP cases, some have been reported to continue to term [42, 43], and in EP after IVF/ICSI, there have been cases that were delivered [18]. …”

Foley Catheter Tourniquet for Uncontrollable Extra-Uterine Placental Hemorrhage: Description of a Novel Surgical Technique

“…A previous case report [1] and review [2] published in Gynecologic and Obstetric Investigation highlight the importance of advanced extra-uterine pregnancy. The condition is rare, but occurs more commonly in lower middle- than high-income countries [3].…”