Evaluating a magnetic resonance imaging of the third-trimester abdominal pregnancy: What the radiologist needs to know

Abstract

Introduction: A 33-week abdominal pregnancy is an extremely rare type of ectopic pregnancy that is potentially life-threatening for the mother and fetus. Reports of using magnetic resonance imaging (MRI) in the third-trimester abdominal pregnancy are very few.

Patient concerns: A 24-year-old woman (gravida 2, para 1, living 0) at 33 weeks' gestation presented to local hospital complaining of vaginal bleeding for 2 months and lower abdominal pain for 2 days. Then, the woman was transferred to our hospital for suspected abdominal pregnancy, which was confirmed at our hospital on ultrasonography and further evaluated in detail on MRI.

Diagnoses: The woman was diagnosed as having abdominal pregnancy.

Interventions: The woman was managed surgically, the unviable fetus was removed, and the placenta was left in situ. Then, the woman was managed with fluids, blood transfusion, antibiotics, and systemic methotrexate after surgery.

Outcomes: At 42 days postoperatively, the affected woman was discharged in a good condition.

Conclusions: By using MRI, we can accurately diagnose an abdominal pregnancy. MRI provides more details than ultrasonography, and explains the possible mechanism of abdominal pregnancy. We advocate using MRI to help surgical planning and improve outcome in cases of abdominal pregnancy.

Figure 1

(A–C) Sagittal T2-weighted single shot fast spin echo images show a fetus in an intact hyper-intense amniotic cavity in the abdomen. The fetus is veiled by irregular amniotic membrane (B and C, AM). Large hypointense opacity (A–C, ∗) floating in the hyperintense amniotic fluid indicates old hemorrhage. The empty uterus (UT) and urinary bladder (UB) are seen in the pelvic cavity. Heterogeneous hyperintense fluid in the pouch of Douglas (A, POD) indicates hemorrhagic content.

Figure 2

(AC) Coronal, sagittal, and axial T2-weighted fast imaging employing steady-state acquisition images show that the placenta is located on the peritoneal surface of the left lateral pelvic and abdominal wall, and inferiorly extending over the peritoneal surface of the uterine front wall (B, UT). Large hypointense opacity of hemorrhage (A–C, ∗) oozes from the edge of the placenta, and floats in the hyperintense amniotic fluid (A/C, AF).

Figure 3

(A–C) At 25 days postoperatively, a CT scan shows that the placenta degenerates to a large cystic mass of encapsulated effusion (A–C, &). The sigmoid colon (A/B, SC) courses along the right lateral portion of the mass. Rectum borders the mass closely.