Abdominal pregnancy (AP), in which the fetus grows outside the female reproductive tract and within the peritoneum, is a very rare type of ectopic pregnancy (EP), accounting for 1% of all EPs [1]. The incidence rate ranges considerably from study to study (1 in 400-50,000 live births), but it must be noted that abdominal pregnancy is the only type of EP that can end as a successful delivery of a full-term newborn [1] [2] [3]. AP is further divided into primary, when the fertilized ovum directly implants at a site within the peritoneal cavity (bowels, the appendix, spleen, and virtually any other organ, as well as blood vessels, uterine structures, and the omentum, are reported sites), whereas secondary implies implantation of the ovum in the peritoneum after initial adhesion in the reproductive tract and its rupture from various reasons [3] [4]. Regardless of the type, the clinical presentation is comprised of the following symptoms - persistent pain, either in the abdomen or in the suprapubic area, nausea, vomiting, painful movements of the fetus, regular menstruation cycles, vaginal discharge (bloody), and malaise [1] [3] [5] [6]. Because the fetus grows adjacent to several vital organs and blood vessels, both the mother and the fetus are at a much higher risk for complications such as severe and uncontrollable bleeding, maternal bowel obstruction, infections, pulmonary embolism, fistula formation (between the amniotic sac and the intestines) and even disseminated intravascular coagulation [1] [2] [7]. Furthermore, perinatal mortality rates reach as high as 50%, and up to half of all children born after an abdominal pregnancy have some congenital abnormality - torticollis, facial or cranial asymmetry, limb defects or deficits of the central nervous system (CNS) are most common, with oligohydramnios being the presumably pathogenic mechanism [1] [4] [6]. Maternal mortality rates, on the other hand, are somewhat lower (around 12%), but these numbers suggest that an early diagnosis can be life-saving [6].

• Gangrene

  Ahmed Samy El-Agwany, El-sayed El-badawy, Ahmed El-habashy, Hesham El-gammal and Mahmoud Abdelnaby, Secondary Advanced Abdominal Pregnancy after Suspected Ruptured Cornual Pregnancy with Good Maternal Outcome: A Case with Unusual Gangrenous Fetal Toes [doi.org]

• Nightmare

  J Womens Health, Issues Care 2:6. doi: 10.4172/2325-9795.1000127 Abstract Post-Date Extrauterine Abdominal Pregnancy in a Rhesus Negative Nullipara with Successful Outcome: A Case Report Abdominal pregnancy is becoming a nightmare to many obstetricians [scitechnol.com]

• Abdominal Pain

  Abdominal pregnancy is a rare, life-threatening condition. A 30-year-old pregnant, gravida 3, para 1, was presented to hospital at 38 weeks gestation. She suffered from abdominal pain at 16 weeks gestation. [ncbi.nlm.nih.gov]

  Four Major causes of Abdominal Pain in Early Pregnancy: Implantation Round ligament pain Miscarriage Ectopic pregnancy Early abdominal pain is common in the first trimester of pregnancy; you may experience some intermittent discomfort along the lower [womenshealthcaretopics.com]

  How to Manage Upper Abdominal Pain During Pregnancy Here are a few tips on how to relieve abdominal pain during pregnancy. [newkidscenter.com]

  The patient suffered from recurrent abdominal pain with painful fetal movements throughout her pregnancy. Diagnosis was missed inspite of ultrasound examination. [scopemed.org]

• Abdominal Mass

  This case highlights the importance of excluding pregnancy in any woman of reproductive age with undiagnosed abdominal mass and utero-vaginal prolapse before any manipulation. [ncbi.nlm.nih.gov]

  If she presents with an ABDOMINAL MASS and a SINUS on her abdominal wall (rare), the sinus may be arising in an ectopic pregnancy. Probe it, you may feel fetal bones. Open it with great care not to injure her gut. [web.archive.org]

  palpation of an abdominal mass distinct from the uterus should raise the suspicion. [1], [4] To assist in pre-operative diagnosis and reduce errors, an array of diagnostic procedures including oxytocin stimulation, abdominal x-ray, hysterosalpingography [annalsafrmed.org]

  Abdominal ultrasound examination during follow-up visit showed involuting placental mass lying in the abdominal cavity surrounded by intestines. [ijcasereportsandimages.com]

  Figure 2 Lithopedion in the process of extraction from abdominal cavity showing adherent omental tissue to calcified mass. [doi.org]

• Suprapubic Pain

  Our patient, however, did not have any symptoms during her pregnancy other than the intermittent suprapubic pain that she experienced at the end of her first trimester. [doi.org]

• Periumbilical Pain

  Besides the on and off abdominal pain, her pregnancy had been uneventful until she developed periumbilical pain prompting her to present to our unit. On examination her blood pressure was 140/90mmHg and other vital signs were within normal limits. [doi.org]

• Hypertension

  […] and edema and protein in the urine abdominal aortic aneurysm an aneurysm of the abdominal aorta associated with old age and hypertension abdominal aorta a branch of the descending aorta toxaemia of pregnancy an abnormal condition of pregnancy characterized [vocabulary.com]

  Methyldopa and nifedipine were commenced for pregnancy-induced hypertension from 22 weeks of gestation. [doi.org]

  Traditionally, pregnant mommies experience low blood pressure when pregnant; however, it is also likely that women may develop hypertension due to disturbance in vessels or alteration in the secretion of some hormones/neurotransmitters. [newkidscenter.com]

  History and physical examination Symptoms of hepatic rupture include the following: RUQ pain and tenderness Possible history of pregnancy-induced hypertension Hemorrhagic shock Distended abdomen Workup The diagnosis can be confirmed through CT findings [emedicine.medscape.com]

• Reduced Fetal Movement

  A 22-year-old woman, gravid 3 para 2 was referred to our centre from a district hospital with complaint of generalized abdominal pain and reduced fetal movements. [ncbi.nlm.nih.gov]

  Case presentation A 22-year-old woman, gravid 3 para 2 was referred to our centre from a district hospital with complaint of generalized abdominal pain and reduced fetal movements. [bmcresnotes.biomedcentral.com]

• Cranial Asymmetry

  Furthermore, perinatal mortality rates reach as high as 50%, and up to half of all children born after an abdominal pregnancy have some congenital abnormality - torticollis, facial or cranial asymmetry, limb defects or deficits of the central nervous [symptoma.com]

  Besides slight cranial asymmetry the examination of the newborn baby was unremarkable. The baby’s head circumference was 32cm (5th centile). [doi.org]

  The most common deformations observed were facial and/or cranial asymmetry and various joint abnormalities. Among the most common malformations were limb deficiency and central nervous system malformations. [dx.doi.org]

  The rate of malformations and deformations is estimated to be about 21%; typical deformations are facial and cranial asymmetries and joint abnormalities and the most common malformations are limb defects and central nervous malformations.Once the baby [en.wikipedia.org]

• Torticollis

  Furthermore, perinatal mortality rates reach as high as 50%, and up to half of all children born after an abdominal pregnancy have some congenital abnormality - torticollis, facial or cranial asymmetry, limb defects or deficits of the central nervous [symptoma.com]

  Fetal malformations such as torticollis, facial asymmetry, malformation of limbs, flattening of the head and thorax, etc., may occur due to severe oligohydramnios. 2 Abdominal pain is the most frequent symptom. [appliedradiology.com]

• Linea Nigra

  Note linea nigra. Figure 2 Placenta and membranes adherent to loop of bowel (posterior view). The meconium-stained bowel was cleaned with normal saline; no obvious bowel defects were noted. [doi.org]

• Agalactia

  A bedside urine analysis showed pus cells and a urine culture subsequently grew Streptococcus agalactiae, which was sensitive to penicillin and amoxicillin. [doi.org]

• Neglect

  Prior reports have neglected to discuss the implications of leaving the placenta in situ on breastfeeding and lactation. [ncbi.nlm.nih.gov]

  Wu MC, Huang WC, Lin HH, Hsiao SM: Severe intra-abdominal bleeding from neglected omental implantation of ectopic tissue after methotrexate treatment for persistent ectopic pregnancy. Fertil Steril 2011;95:2435.e2431-e2433. [karger.com]

• Amenorrhea

  A 35-year-old, para 2, unbooked, Ethiopian Somali woman presented with amenorrhea of 9 months' duration, abdominal pain, and painful fetal movements of 4 months' duration. [ncbi.nlm.nih.gov]

  The 28-year-old woman in this instance had a history of amenorrhea and pelvic inflammatory disease. She had previously undergone dilatation and curettage, as well as tuboplasty. Fertility treatment was used for her to successfully conceive. [auntminnie.com]

  At 2 months amenorrhea she gave a history of acute abdominal pain associated with spotting per vaginum. Emergency ultrasound done elsewhere at that time confirmed the presence of single live intrauterine gestation. [appliedradiology.com]

Unfortunately, the diagnosis of an abdominal pregnancy is often missed, especially in the first few months of gestation, and studies report that more than 50% of cases were not diagnosed on regular ultrasonographic exams [5] [6] [7]. For this reason, clinical judgment is necessary during diagnostic workup. A high index of suspicion must be present if patients report excessive abdominal pain in the first semester, bleeding, previous pelvic surgery, and a history of infertility, implying that a properly obtained patient history is vital in making a presumptive diagnosis [6]. A meticulous physical examination is equally important, as relatively easy palpation of fetal limbs and an abnormal lie, as well as abdominal or suprapubic tenderness, are important features of AP [1] [6]. Once clinical criteria have been solidified, imaging studies are used for confirmation. Standard fetal ultrasonography, however, may not reveal any pathological findings unless the physician patiently looks for the uterus and reveals an empty uterine cavity [1]. Insertion of a balloon catheter into the uterus is often recommended to confirm the absence of the fetus inside the uterus [1] [6]. A definite diagnosis can be made by performing more advanced imaging studies, either computed tomography (CT) or magnetic resonance imaging (MRI) [2] [3]. Laboratory studies are usually normal for a regular pregnancy, showing high levels of human chorionic gonadotropin (βhCG) and/or serum alpha-fetoprotein (AFP) [1].

• Ovarian Mass

  Pregnant women are predisposed to adnexal torsion, with approximately 20% of adnexal torsions occurring during pregnancy. [6, 89] The condition is associated with an ovarian mass in 50-60% of patients; the mass is most often a dermoid. [emedicine.medscape.com]

We compared and analyzed the pregnancy history, gestational age when the diagnosis was confirmed, the placental colonization position, the course of treatment and surgical processes, related concurrency rate, post-operative drug treatment programs, and [ncbi.nlm.nih.gov]

Uterine anomalies, their imaging and diagnosis, as well as the patient's subsequent reproductive prognosis are discussed. [ncbi.nlm.nih.gov]

Treatment and prognosis It is a serious and potentially life-threatening condition. [radiopaedia.org]

Tamarit G, Lonjedo E, Gonzalez M, Tamarit S, Domingo S, Pellicer A: Combined use of uterine artery embolization and local methotrexate injection in interstitial ectopic pregnancies with poor prognosis. Fertil Steril 2010;93:1348 e1341-e1344. [karger.com]

Ectopic pregnancies should be identified early and evaluated for the etiology of the presentation. Rarely, an ectopic pregnancy implants at an extratubal location. [ncbi.nlm.nih.gov]

The etiology and mechanism of development of idiopathic CTEV is unknown [44]; one can only speculate about the role of AAP in the development of CTEV. [webmedcentral.com]

Article information Author: Gwinyai Masukume First submitted: 13 November 2014 Accepted: 20 November 2014 Last updated: 1 January 2019 Reviewer comments Author info: Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health [en.wikiversity.org]

[…] placental regression. [18] Complications of leaving the placenta can include residual bleeding, infection, bowel obstruction, pre-eclampsia (which may all necessitate further surgery) [19] [18] and failure to breast feed due to placental hormones. [20] Epidemiology [doi.org]

Multiparity and poor socio-economic status are implicated as epidemiological factors 7. Clinical presentation can be variable with abdominal pain occurring at 16-17 weeks gestation 8, 9 as was observed in our patient. [ncbi.nlm.nih.gov]

When an abdominal pregnancy is ended surgically, the surgeon must take steps to prevent heavy bleeding at the place of implantation. [everydayhealth.com]

Enough fluid intake Drinking sufficient quantities of water can prevent abdominal pain caused by constipation and bloating. It keeps the metabolic system up and going and prevents dehydration. [newkidscenter.com]

However, only one of nine women who reached the hospital alive had an accurate preoperative diagnosis of abdominal pregnancy, which suggests that preventing abdominal pregnancy-related death may depend, at least in part, upon increasing physicians' awareness [ncbi.nlm.nih.gov]

Treatment and Prevention “Modern medicine can provide open treatment only and keep the tube in some cases. In case of surgical procedure, laparoscopy procedure is used. [pinkycloud.com]

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