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Introduction: Heterotopic pregnancy is the existence of both intrauterine pregnancy and ectopic pregnancy simultaneously. Heterotopic pregnancy (HP) has been a rare type of multifetal pregnancy. Heterotopic abdominal pregnancy (HAP) is a very rare diagnosis with very few reported cases. Case Presentation: We reported a rare case of HAP in a 32-year-old woman (G2L1) with a history of 13 weak amenorrhea and mild pelvic pain presenting with two live fetuses in the 13th week. The patient also did not mention any risk factor of ectopic pregnancy such as pelvic inflammatory disease, assisted reproductive techniques, endometriosis, and multiparity. Diagnosis of HAP was performed with the use of sonography and magnetic resonance imaging. We managed the patient with emergency laparotomy due to acute abdominal pain a few hours after admission. Laparotomy revealed the rupture of the left fimbria with 500 cc hemoperitoneum. The excision of the ectopic gestational sac in the cul-de-sac and left salpingectomy with preserving the intrauterine fetus was performed. The patient finally gave birth to one live term birth. Conclusions: Physicians should consider the possibility of HP in women with spontaneous pregnancy and abdominal pain. Both sonography and MRI should be performed to help timely diagnosis. [ABSTRACT FROM AUTHOR]

Abdominal pregnancy is a rare form of ectopic gestation. It accounts for about 0.4% of all cases of ectopic pregnancy, and often associated with significant morbidity and mortality. Clinical presentation varies, and diagnosis is commonly challenging. Although ultrasound is helpful in early gestation, this could be unsatisfactory at advanced gestational age. Hence, a high index of suspicion is required in the diagnosis. We present a case of secondary abdominal pregnancy in a 27-year-old gravida 2 para 0 + 1 at an estimated gestational age of 33 weeks and 5 days. She had ultrasound scan done at 9 weeks and 2 days confirming the diagnosis, but declined surgery to seek spiritual intervention. She subsequently presented with generalized abdominal pain and fainting attack. She had exploratory laparotomy with delivery of a live female baby with no congenital anomaly. The placenta was attached to the left infundibulopelvic ligament and was delivered wholly without remnants. She was discharged on the 8th postoperative day, and the baby was discharged after 14 days from the neonatal intensive care unit. Accurate diagnosis and prompt intervention with evaluation of placenta attachment is vital to prevent adverse consequences. [ABSTRACT FROM AUTHOR]

Advanced extrauterine pregnancy is an extremely rare, life-threatening pregnancy complication. Management of these pregnancies presents significant challenges, especially when they have progressed to an advanced stage of fetal viability. With high rates of maternal and fetal mortality associated with this complication, delivery or pregnancy interruption should be expedited following diagnosis. Localization of the placenta and its blood supply is critical to preoperative planning. Hybrid operating suites that can accommodate a multidisciplinary team of subspecialists may improve the chance of a successful outcome with this rare complication.

Abdominal pregnancy is a rare form of ectopic pregnancy with very high morbidity and mortality for both the mother and the fetus. Diagnosis and management can pose some difficulties especially in low resource centres. High index of suspi­cious is vital in making prompt diagnosis in such situations. A young lady of 30 years presented with 2nd gravida at 31 wks pregnancy with pain in the whole abdomen having loose motion admitted in Dept of Obs and Gynae BSMMU. She was diagnosed as a case of 31 wks pregnancy with gastroenteritis. She was treated conservatively according to advice of gastroenterologist and was discharged after improvement. Patient was readmitted again with pervaginal watery discharge. Decision for cesarean section was taken because of transverse lie, fetal growth restriction with severe oligohydramnios. After opening the abdomen, abdominal pregnancy was diagnosed. Following delivery of the baby significant bleeding started which was secured with ligature. Placenta was kept in situ. Mother and baby were discharged healthy on fourteenth postoperative day.

Abdominal pregnancies constitute 1% of ectopic pregnancies, among which broad ligament pregnancy is a rare form. The maternal mortality rate has been reported to be as high as 20%. The diagnosis is seldom established before surgery. Laparoscopic management of broad ligament ectopic pregnancy is the ideal form of treatment in appropriately selected patients. We present the case report of successful laparoscopic treatment of a 3x3.5cm broad ligament pregnancy. A search of literature shows that ours is the 6th case report of such a rare ectopic pregnancy managed endoscopically successfully.

El litopedion ocurre usualmente cuando un óvulo fertilizado se adhiere a cualquier lugar fuera del útero: el feto puede comenzar a crecer, pero no puede sobrevivir y muere. El sistema inmunológico de la madre eventualmente reconoce al feto como un objeto extraño y para protegerla de una posible infección, reacciona revistiendo el feto con una sustancia rica en calcio mientras ocurre la deshidratación de los tejidos. Se forma una pared mediante el depósito de calcio, el feto se convierte en un litopedion momificado. De la evaluación multidisciplinaria depende la intervención quirúrgica adecuada y la evolución favorable de la paciente. Se describir una nueva forma de presentación del litopedion coexistiendo con embarazo ectópico y mostrar la experiencia de un caso de difícil diagnóstico y manejo quirúrgico son los objetivos del estudio. Se presentó el caso de una gestante de 28 años tratada en el Servicio de Ginecología y Obstetricia del Hospital General de Bengo (República de Angola), portadora de una gravidez ectópica abdominal en proyección epigástrica (litopedion), concomitando con una gravidez de seis semanas intrauterina. Se revisó la literatura sobre el tema y se desarrolló una exposición de las características clínicas, diagnóstico, manejo y pronóstico de la enfermedad.The Lithopedion usually occurs when a fertilized egg adheres somewhere outside the uterus; the fetus may star to grow, but it cannot survive and dies. The mother’s immunologic system eventually recognizes the fetus as a foreign body and reacts to protect her from a possible infection, covering the fetus with a calcium-rich substance while the dehydration of the tissues is taking place. Through the calcium deposits, a wall is formed, and the fetus becomes a mummified lithopedion. The adequate surgery and favorable evolution of the patient depends on the multidisciplinary evaluation. Describing a new presentation form of the lithopedion coexisting with an ectopic pregnancy and showing the experience of a case of difficult diagnosis and surgical management are the objective of the research. We present the case of a pregnant woman aged 28 years old, treated in the Service of Gynecology and Obstetrics of the General Hospital of Bengo (Republic of Angola), who presented an abdominal ectopic pregnancy in epigastric projection (lithopedion) coinciding with a six-week intrauterine pregnancy. We reviewed the literature on the theme and developed an exposition of the disease clinical characteristics, diagnosis, management and prognosis.

Background: Abdominal pregnancy is a variety of ectopic pregnancy with intraperitoneal implantation exclusive of tubal, ovarian or intraligamentous pregnancy. Abdominal pregnancy is rare with frequency directly related to the frequency of ectopic gestations in the population. The worldwide incidence ranges from 1:1320 to 1:10200 births. Objective: To report a case of abdominal pregnancy in South-South region of Nigeria and highlight the clinic-radiological diagnosis of this condition. Methodology: The medical record of the patient was reviewed then literature of the relevant subject was medline searched. Case report: a 30-year-old primigravida presented to the central hospital Ughelli in the South-south zone of Nigeria for ANC at 12 weeks gestation by date and complained of recurrent paraumbilical pains of 2 months duration. Clinical examination revealed stable vital signs but the uterus was not palpable. An obstetrics scan done later showed a singleton inactive fetus, extra uterine in location. Other significant findings were oligohydramnios and extra-uterine placenta. The G.A was 22 weeks 1 day +/- 14 days. An impression of abdominal pregnancy with fetal death was made. Radiology is central in the definitive diagnosis. Ultrasonography is recommended as a rapid non-invasive method to aid in diagnosis. The classic finding is an empty uterus separate from the fetus (100% of case diagnosed) At emergency laparotomy the finding included a dead fetus attached to the greater omentum. Conclusion: the diagnosis of advanced abdominal pregnancy by ultrasound is vital to avert morbility /mortality

Abdominal pregnancy is a rare form of ectopic pregnancies, accounts less than 1% of all types of ectopic pregnancy. Its significance comes from high morbidity and mortality rates., Case Presentation: We present a case of a 22-year-old shocked patient with acute abdominal pain underwent laparotomy, abdominal pregnancy implanted into the posterior wall of the uterus diagnosis was made, and appropriate follow-up was offered., Clinical Discussion: Acute abdominal pain may be the main symptom of the abdominal pregnancy. The diagnosis was made by direct visualization of the products of conception and pathological study confirmed., Conclusion: The first case of abdominal pregnancy is implanted into the posterior wall of the uterus. Follow-up is recommended until β-human chorionic gonadotropin levels become undetectable., Competing Interests: The authors declare that they have no financial conflict of interest with regard to the content of this report., (© 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Ectopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with assisted-reproductive technology (ART), occurring in approximately 1. 5-2.1 % of patients undergoing in-vitro fertilization (IVF). Abdominal ectopic pregnancy is a rare yet clinically significant form of ectopic pregnancy due to potentially high maternal morbidity. While risk factors for ectopic pregnancy after IVF have been studied, very little is known about risk factors specific for abdominal ectopic pregnancy. We present a case of a 30 year-old woman who had an abdominal ectopic pregnancy following IVF and elective single embryo transfer, which was diagnosed and managed by laparoscopy. We performed a systematic literature search to identify case reports of abdominal or heterotopic abdominal ectopic pregnancies after IVF. A total of 28 cases were identified. Results: Patients' ages ranged from 23 to 38 (Mean 33.2, S.D. = 3.2). Infertility causes included tubal factor (46 %), endometriosis (14 %), male factor (14 %), pelvic adhesive disease (7 %), structural/DES exposure (7 %), and unexplained infertility (14 %). A history of ectopic pregnancy was identified in 39 % of cases. A history of tubal surgery was identified in 50 % of cases, 32 % cases having had bilateral salpingectomy. Transfer of two embryos or more (79 %) and fresh embryo transfer (71 %) were reported in the majority of cases. Heterotopic abdominal pregnancy occurred in 46 % of cases while 54 % were abdominal ectopic pregnancies. Conclusions: Our systematic review has revealed several trends in reported cases of abdominal ectopic pregnancy after IVF including tubal factor infertility, history of tubal ectopic and tubal surgery, higher number of embryos transferred, and fresh embryo transfers. These are consistent with known risk factors for ectopic pregnancy following IVF. Further research focusing on more homogenous population may help in better characterizing this rare IVF complication and its risks. [ABSTRACT FROM AUTHOR]

Splenic ectopic pregnancies are a rare cause of abdominal pain in reproductive-age women. A 21-year-old woman with worsening abdominal pain and a positive pregnancy test presented with hemoperitoneum and no intrauterine pregnancy on transvaginal ultrasound. After 2 nondiagnostic laparoscopies, a splenic pregnancy was diagnosed by computed tomography scan and abdominal ultrasound. Currently, diagnosis and treatment of splenic pregnancies involve exploratory surgery and splenectomy. We report the successful treatment of this splenic ectopic pregnancy with combined intramuscular plus ultrasound-guided percutaneous methotrexate injection, with preservation of the patient's spleen. Abdominal implantation must be considered in patients with pregnancy of unknown location, and in carefully selected patients splenic ectopic pregnancy can be successfully managed by minimally invasive methods. [ABSTRACT FROM AUTHOR]

Introduction: This paper proposes an approach to maternal health from the care process perspective to understand how determinants of health manifest in the daily experience of women. Objective: To describe and analyze the interaction between the domestic and clinical care during pregnancy and post-partum among women who live in adverse socio-economic conditions. Methodology: Qualitative study based on semi-structured and in-depth interviews, participant observation, and analysis of secondary sources. Twenty women who received care at a maternity clinic in the city of Cartagena, Colombia were interviewed. Participants had an average age of 25, lived in adverse socio-economic conditions and had at least one of the following obstetric risks: preterm labor symptoms, previous abortions, or mild preeclampsia. Participant observation took place at the clinic and at the residence of four patients. In addition, six in-depth interviews were conducted with health workers of the clinic. Results: The socio-economic conditions of women and their family dynamics determine their experiences of maternity. Relatives, usually other women, are the main agents of care. The most important care activities revolve around physical activities, transportation, nutrition, and exposure to the environment. The characteristics of domestic care play an important role in the clinical environment. Conclusion: Family-centered care requires acknowledging the role of relatives and other members of the women's social networks as guides in the healthcare process. Likewise, recognizing the socio-economic conditions of women requires adapting health services to the needs of women and their families in order to avoid reproducing social inequalities. [ABSTRACT FROM AUTHOR]

Background: Pregnancy in a rudimentary horn of a unicornuate uterus is rare in obstetrics and when it occurs, it seldom progresses to term as ruptures frequently occur before the third trimester. Case history: A 29 year old female, presented at 42 weeks 5 days complaining of absent foetal movements, with results of a self-prescribed ultrasound scan showing an "abdominal pregnancy with foetal demise". She was haemodynamically stable and there were no foetal heart tones. At laparotomy, a non-communicating rudimentary horn pregnancy (RHP) was discovered. The right horn and tube were resected, with delivery of a post term female stillbirth. There were no postoperative complications. Conclusion: Rudimentary horn pregnancies are difficult to diagnose when advanced; especially in low-resource settings with suboptimal antenatal care. Maternal and foetal outcomes in RHPs are usually poor; RHPs should therefore be suspected in pregnancies with atypical ultrasonographic features and more investigations done to confirm the diagnosis in order to reduce the associated morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Abdominal pregnancy (pregnancy in the peritoneal cavity) is a very rare and serious type of extrauterine gestation that accounts for approximately 1.4% of all ectopic pregnancies. It also represents one of the few times an ectopic pregnancy can be carried to term. Early strategic diagnosis and management decisions can make a critical difference with regards to severity of morbidity and mortality risk. After an extensive search of the English language medical literature, we are unaware of any case of abdominal pregnancy in which the placenta was receiving its vascular supply from the sacral plexus.Case Presentation: A 26-year-old African-American woman, primigravida, at 16 weeks 4 days' gestation, presented to our Emergency Department with abdominal pain. She did not complain of any vaginal bleeding. A physical examination revealed mild abdominal tenderness and no blood in the vaginal vault. Laboratory findings corresponded to an increased level of beta human chorionic gonadotropin; magnetic resonance imaging confirmed an abdominal pregnancy. She underwent feticide, administration of methotrexate and a laparotomy was done which was immediately deferred due to perceived increased bleeding risk. She was found to have an intra-abdominal ectopic pregnancy with the placenta attached to her omentum, cul-de-sac and rectosigmoid, with unusual and extensive vascularity from the sacral plexus. A repeat laparotomy was performed 11 weeks later, aimed at removal of the gestational sac and placenta that were left in situ on the first laparotomy. This time, we achieved successful removal of the peritoneal gestation, lysis of adhesions, ligation of vascular supply and cautery of the diminished vasculature. Subsequently, she had two ectopic pregnancies, which were managed with both medical and surgical interventions.Conclusions: Ectopic pregnancies should be identified early and evaluated for the etiology of the presentation. Rarely, an ectopic pregnancy implants at an extratubal location. Today, early intervention saves lives and reduces morbidity, but ectopic pregnancy still accounts for 4 to 10% of pregnancy-related deaths and leads to a high incidence of ectopic site gestations in future pregnancies. Medical management has emerged as a safe alternative to surgery and holds promise for preservation of future fertility; however, surgery remains an acceptable modality. We found that careful and strategic choice of management pathway can make all the difference to a favorable outcome. As emergency physicians, we need to be aware of the possibility of abdominal ectopic pregnancy in such presentations and its severe consequences if it remains undiagnosed. [ABSTRACT FROM AUTHOR]

Background: Despite advances in diagnostic imaging and focused antenatal care, cases of undiagnosed abdominal pregnancies at term are still reported in obstetric practice. It is atypical and very rare for a patient to be asymptomatic late in pregnancy and for the pregnancy to result in a live birth with no evidence of intrauterine growth restriction despite the unfavourable implantation site. This late term asymptomatic presentation despite routine antenatal care demonstrates a diagnostic challenge. Case presentation: We report a case of a 26 year old Primigravida with an asymptomatic and undiagnosed abdominal pregnancy carried beyond 41 weeks of gestation espite routine antenatal care and serial ultrasound reports. She presented for a routine antenatal care visit at 41 weeks of gestation. Induction of labour was initiated due to the late term gestation but was unsuccessful. At this point the fetus developed severe tachycardia and CTG confirmed persistent non-reassuring foetal heart rate patterns. The mother was then prepared for an emergency caesarean delivery. Abdominal pregnancy was only diagnosed at laparotomy where a term male baby weighing 3108 g was delivered with an Apgar Score of 7 and 8 at 1 and 5 min respectively. The placenta which was implanted into the omentum, ileal mesentery and extending to the pouch of Douglas was removed following active bleeding from its detached margins. She was transfused with two units of blood and four units of fresh frozen plasma. Postoperative morbidity was minimal with transient paralytic ileus on the second post-operative day. Her recovery was otherwise uneventful and she was discharged on the seventh post-operative day in good condition. The neonate developed meconium aspiration syndrome and passed away on the 2nd day of life despite having undergone standard care. A post-mortem examination was not performed because the family did not consent to the procedure. Follow up of the mother at 2, 6 weeks and 6 months postpartum was uneventful. Conclusions: This atypical presentation of an asymptomatic abdominal pregnancy carried tolate term and only diagnosed at laparotomy despite routine antenatal care demonstrates a significant lapse in diagnosis. Clinicians and radiologists must always bear this possibility in mind during routine client evaluation. Skills training in Obstetric ultrasound and in the clinical assessment of obstetric patients should emphasize features suggestive of abdominal pregnancy. This will improve diagnosis, ensure appropriate management and minimise complications. Immediate termination of pregnancy can be offered if the diagnosis is made before 20 weeks of gestation. Patients diagnosed with advanced abdominal pregnancies and are stable can be monitored under close surveillance and delivered at 34 weeks of gestation after lung maturity is achieved. Although removal of the placenta carries a higher risk of haemorrhage, a partially detached placenta can be delivered with minimal morbidity and a good maternal outcome. Given the documented low survival rates of neonates in such cases, neonatal units must be adequately equipped and staffed to support them. Post-mortem examination is important to confirm cause of death and exclude other complications and congenital anomalies. Communities need to be educated about the importance of this procedure. [ABSTRACT FROM AUTHOR]

Abdominal pregnancy is a rare obstetric complication with a high maternal morbidity and mortality. It can be primary or secondary. Secondary abdominal pregnancy results atier early rupture of tubal ectopic pregnancy into the peritoneal cavity. Incidence is 1 in 10,000, where as a case of advanced secondary abdominal pregnancy with live birth is 1 in 25,000 pregnancies. When it is recognized, immediate laparotomy with removal of foetus is usually recommended. Expectant management carries a risk of sudden life threatening intra-abdominal bleeding and generally poor foetal prognosis. In advanced cases, overall mortality rate of mother is 0.5 to 8%. If laparotomy is done in emergency, then placenta should be removed as much as possible without compromising the maternal condition. Later on methotrexate, if required, is a good treatment option with supportive therapy of blood transfusion in postoperative period. Many authors have described pregnancies carried to term with live births with various foetal congenital malformation, poor foetal outcome and high neonatal mortality. We have a series of three cases of secondary abdominal pregnancy out of which two resulted in live births of babies and another one was terminated at 24weeks of gestation. [ABSTRACT FROM AUTHOR]

Background and Objectives: A case of advanced abdominal pregnancy, diagnosed at 30 weeks gestation by ultrasonograpy is presented. A 25 year old, G2P0+1 presented at 30 weeks of gestation with abdominal pain. Abdominal pregnancy was diagnosed by ultrasound scan. It was a primary abdominal pregnancy, confirmed by Studdiford criteria. Methods: Laparotomy was carried out, baby was lying transversely with head on left side and placenta adherent to posterior uterine wall, bowel loops and anterior abdominal wall. The baby was taken out and Placenta was left insitu. Results: The patient started fever on 5th post operative day which was settled with change of antibiotic. On 40th post operative day signs of abdominal distension developed. 2nd look laparotomy was performed, placenta was removed. Patient condition was satisfactory at the time of discharge. Conclusion: Ultrasound examination is the usual diagnostic procedure of choice to diagnose abdominal pregnancy. In addition magnetic resonance imaging can be useful to localize the placenta preoperatively. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article describes the case of a 16-year-old prime gravida female patient with history of amenorrhea with sudden severe generalized abdominal pain and who was diagnosed with abdominal pregnancy and live fetus.

Background. There are increasing reports of term live abdominal pregnancies even though the diagnosis of abdominal pregnancy is made preoperatively only in 45% of cases which partly explains the high maternal and perinatal morbidity and mortality associated with abdominal pregnancy. Case Report. We report a rare case of misdiagnosed term abdominal pregnancy complicated by fetal demise due to cord round neck in a 29-year-old G3P2002 at 39-week and 1-day gestation. She noticed reduced fetal movements for which upon examination fetal death was diagnosed. Cervical ripening was started which eventually failed, and surgery was indicated. Findings were an abdominal pregnancy with a third-degree macerated fetus with cord round neck. She was discharged on day 8 postoperation to continue follow-up as an outpatient with regular βHCG and ultrasound checks. Conclusion. This case illustrates the need to effectively confirm an intrauterine location of a pregnancy even in a case of fetal demise and the need to monitor for cord abnormalities in advanced abdominal pregnancy being managed expectantly. [ABSTRACT FROM AUTHOR]

It is well known that the incidence of ectopic pregnancy has increased significantly with the prevalence of assisted reproductive technologies such as in vitro fertilization and embryo transfer (IVF-ET). Almost all ectopic pregnancies following IVF-ET are actually tubal pregnancies just like ectopic pregnancy following natural conception. Abdominal pregnancy is a rare form of ectopic pregnancy (< 1% of all ectopic pregnancies) and therefore abdominal pregnancy following IVF-ET is very rare. Recently, we experienced a case of abdominal pregnancy following IVF-ET treated with laparoscopic surgery at 10 weeks' gestation. The possibility of an ectopic pregnancy including abdominal and heterotopic pregnancies should be considered in any pregnant woman following IVF-ET. A diagnostic laparoscopy is a very suitable procedure for looking into the abdominal cavity in case of such a rare ectopic pregnancy.

Relatamos un caso de embarazo abdominal que se complicó con hemoperitoneo ocurrido en el primer trimestre. Ambas trompas, ovarios y el útero se encontró intacto. El sitio de implantación era el fondo de saco de Douglas, en la superficie anterior del rectoWe report an abdominal pregnancy complicated with hemoperitoneo during the first trimester. Both fallopian tubes, both ovaries and the uterus were completely normal. The site of implantation was found in the cul-de-sac of Douglas, on the anterior surface of the rectum

Adbominal pregnancy is a rare and life-threatening from of ectopic pregnancy. The incidence is 10.9 per 100000 births and 9.2 per 1000 ectopic gestations. The abdominal pregnancy may rarely continue to term and if it happens the maternal and perinatal mortality and morbidity are increased. This paper reports on a 26-year-old multigravida with 41 weeks abdominal pregnancy managed successfully with good maternal and perinatal outome.