In an abdominal pregnancy, the embryo or fetus grows and develops outside the womb in the abdomen, which is different from its development in the Fallopian tube, ovaries, and broad ligaments of the uterus.
Pregnancies in the tubal, ovaries and broad ligaments have been regarded as difficult to diagnose and treat as those occurring in the abdomen. Therefore, has never been considered to be abdominal pregnancies.
Others—in the minority—hold the position that there should be a placenta placed in the peritoneum to determine abdominal pregnancy status.
Signs and symptoms of abdominal pregnancy
There are nonspecific symptoms which may include abdominal pain or vaginal bleeding when pregnant in areas where ultrasounds aren’t available, which could lead to the diagnosis only being discovered when surgery is performed to investigate the abnormal symptoms. They are typically detected later in the developing world than in developed countries. About half of all diagnoses from developed countries cannot be explained by the absence of symptoms. [1]
People with an abdominal pregnancy are at risk of low blood pressure, hematoma, anemia, pulmonary embolism, coagulopathy, and infection. Other causes of death include anemia, pulmonary embolism, coagulopathy, and infections.
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Risk factors of abdominal pregnancy
Sexually transmitted diseases play a major role, [2] but what about half of the women who are unaware that they are pregnant had a previous tubal pregnancy or trauma damage to the Fallopian tubes from previous surgery, or from prior ectopic pregnancy). To read more briefly about ectopic pregnancy check our article: Ectopic pregnancy: Causes, Symptoms, and Treatment
Mechanism
The peritoneum of the pelvic and abdominal wall, the rectouterine pouch, the omentum, the mesentery, the bowels, and the peritoneum outside the uterus are the most commonly used implantation sites.
There could be several organs attached to the growing placenta including the tube and ovary.
There have also been rare cases of a hepatic pregnancy or a splenic pregnancy in the liver and spleen. Even an embryo was found growing on the diaphragm under a patient’s skin, with early diaphragmatic pregnancy.
Primary versus secondary implantation
An abdominal primary pregnancy is one where the cervix becomes the only place where the fertilized egg implants, thereby voiding the tubes and ovaries; such pregnancies are extremely rare, being reported in 24 cases in 2007.
Another mechanism for a secondary abdominal pregnancy is uterine rupture and cervix rupture. Besides, fetal abortion is also an abdominal pregnancy if it started as tubal implantation and also re-implanted after the implantation process.
Diagnosis of abdominal pregnancy
An abdominal pregnancy can involve symptoms of abdominal discomfort, vaginal bleeding, or GI symptoms under the guise of “being not quite right” or even displaying normal signs of pregnancy. (For more read: False (Phantom) Pregnancy: Causes, Symptoms, and Treatments)
A woman who has a displaced cervix, ultrasound confirmed pregnancy, or labor that fails to progress to term can further determine whether there is a pre-labor abscess. The diagnosis can be confirmed with X-rays.
This can be demonstrated with sonography. Placental fluid and uterine wall are reduced to no present and the pregnancy is outside a womb.
The abdominal tissues of the fetus are located close to the abdominal wall. The placenta looks abnormal, and the fetus has an abnormal lie. There are also free fluids in the abdomen.
Alpha-fetoprotein levels elevated during abdominal pregnancy are another sign of pregnancy. MRIs can be used to diagnose abdominal pregnancies and plan for surgery.
Ultrasound
Using ultrasound is generally a good decision in diagnosing most cases. However, the diagnosis could be missed depending on the operator’s skill.
Criteria
Studdiford’s criteria should be fulfilled to diagnose a primary abdominal pregnancy: the tubes and ovaries must be normal. There should be no abnormal connection between the uterus and the abdominal cavity, and the pregnancy must indicate that there was no previous tubal pregnancy. Gradually, Friedrich and Rankin added microscopic findings to Studdiford’s criteria in 1968.
Differential diagnosis
An internal pregnancy may be classified as anything from an acute abdominal infection to the following: miscarriage, intrauterine fetal death, placental abruption, a fibroid uterus that has an active pregnancy.
Treatment
Medical personnel from different specialties should ideally be included in a management team that manages abdominal pregnancy. Potential treatments include laparoscopic or laparotomy termination of pregnancy, methotrexate treatment, embolization treatment, and combinations of these.
When the following criteria are met, conservative therapies are indicated:
- The probability of congenital malformations is quite low.
- The fetus is alive
- Hospitalization during pregnancy is possible in a well-equipped maternity ward where immediate transfusion capabilities are available.
- The well being of both mothers and babies is monitored carefully
- The site of the placental implant varies depending on how close the liver and spleen are to the abdomen.
Diagnosis of advanced abdominal pregnancy implies treatment; however, the situation is more complex in this case.
Advanced abdominal pregnancy
In cases of advanced abdominal pregnancy, the pregnancy can extend beyond 20 weeks, rather than the 20 weeks of normally regarded abdominal trimesters. Those cases have been reported in the lay press frequently, with live babies being called ‘miracle babies’. An erectile dysfunction patient is commonly miscarried due to a dead fetus. Over time, the fetus becomes calcified and becomes a lithopedion.
When an abdominal pregnancy is diagnosed, a laparotomy should usually be performed. However, if the baby is alive and medical support systems are in place, careful monitoring may be considered to bring the child to viability.
Women suffering from an abdominal pregnancy will not give birth. They will deliver by laparotomy, and their child’s survival rate reduces significantly. 40-95% of babies survive an abdominal pregnancy. This preggers infant mortality rates.
An abdominal pregnancy can result in birth defects when there is no uterine wall to prevent compression and there may be an insufficient amount of amniotic fluid surrounding the unborn child.
Malformations and deformations are estimated to be 21%; the most common malformations and deformations are limb deformities and central nervous system defects; typical deformities are facial and cranial asymmetries and joint abnormalities.
With an abdominal pregnancy, placental management becomes a complex issue. Normal delivery controls blood loss through the contraction of the uterus; however, the placenta is located in protected tissue that cannot contract, and removal of it can result in life-threatening blood loss. Patients with that kind of pregnancy are frequently treated with blood transfusion, with some even utilizing tranexamic acid and recombinant factor VIIa, which both minimize blood loss.
Placentas normally cannot just be removed or tied off; they must remain alive to ensure natural development. This takes approximately 4-6 months and can be monitored by clinical examination, hCG levels, and ultra-sounds.
mifepristone used to promote placental regression has also been widely used to promote placental regression, which has been shown to promote placental regression due to a large amount of necrotic tissue available for infection.
Angiograms have been used to diagnose placental obstruction by embolization, including placental bleeding, infection, bowel obstruction, pre-eclampsia, and failure to breastfeed caused by placental hormones.
The outcome can be good for the mother and the baby with abdominal pregnancy, Lampe describes a case where the mother and baby were fine well after 22 years of surgery because of abdominal pregnancy.
Epidemiology
A report from Nigeria places the frequency at 34 out of every 100,000 deliveries, while the Zimbabwean report is 11 out of 100,000. The maternal mortality rate above the US average for ectopic pregnancies is approximately five to ten times the national average.