Advanced abdominal pregnancy: an increasingly challenging clinical concern for obstetricians

Abstract

Advanced abdominal pregnancy is rare. The low incidence, high misdiagnosis rate, and lack of specific clinical signs and symptoms explain the fact that there are no standard diagnostic and treatment options available for advanced abdominal pregnancy. We managed a case of abdominal pregnancy in a woman who was pregnant for the first time. This case was further complicated by a concurrent singleton intrauterine pregnancy; the twin pregnancy was not detected until 20 weeks of pregnancy. The case was confirmed at 26 weeks gestational age using MRI to be an abdominal combined with intrauterine pregnancy. The pregnancy was terminated by cesarean section at 33 + 5 weeks gestation. We collected the relevant data of the case while reviewing the advanced abdominal pregnancy-related English literature in the Pubmed, Proquest, and OVID databases. 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 follow-up results with the expectation to provide guidance for other physicians who might encounter similar cases.

Keywords: Advanced abdominal pregnancy; clinical; obstetricians.

Figure 1

Transvaginal ultrasound results of a 26-week pregnancy (longitudinal). The abdominal pregnancy fetus is posterior to the cervix. The surface did not reach the muscular layer of the uterus.

Figure 2

Pre-operative MRI results. Pre-operative magnetic resonance imaging indicated a breech fetus in the uterus. Posterior to the uterus, an abdominal pregnancy with a single breech fetus can be seen. The abdominal pregnancy placenta is located inferior to the uterine wall.

Figure 3

Intra-operative photograph. A is the uterine pregnancy; the anterior incision was completely sutured. B is the abdominal pregnancy sac with an intact surface and visibly abundant blood vessels.

Figure 4

Fourteen days after surgery, a post-operative ultrasound indicated rich blood flow signals of the residual abdominal pregnancy placenta.

Figure 5

After 50 days of surgery, the ultrasound results suggested a small amount of placental blood flow signals at the edge of the abdominal pregnancy residual placenta.

Figure 6

MRI results of the follow-up after 1 year. Placenta located at the uterorectal fossa did not significantly shrink in size. The border with the anterior uterus was not clear. No obvious bowel oppression symptoms were noted.

Figure 7

MRI results of the follow-up after 2 years. After 2 years, a MRI still indicated that the placenta was at the uterorectal fossa and was not significantly reduced in size. The border with the anterior uterus was not clear. No obvious bowel oppression symptoms were noted.