Abdominal pregnancy in early and late gestation

Background: Abdominal pregnancy is a rare form of ectopic pregnancy characterized by an increased risk of serious obstetric complications, maternal morbidity and mortality, neonatal morbidity and perinatal loss. Despite the use of modern imaging techniques in prenatal diagnosis, detection of abdominal pregnancy remains a difficult task and in most cases the pathology is not diagnosed before surgical intervention.

Case report: The paper presents two clinical cases of abdominal pregnancy that were observed in the same period of time. In the first case, laparotomy was performed at 34 weeks gestation for abdominal pain in a multiparous patient with placenta increta (PAS Grade 2) and progressive oligohydramnios; abdominal pregnancy was detected intraoperatively. A live infant without developmental anomalies was born. Hysterectomy was performed due to the attachment of the placenta into the uterine wall (PAS Grade 2), blood loss was 3000 ml. In the second case, abdominal pregnancy was also localized on the uterus, but the pregnancy was terminated early and the diagnosis was made only during emergency laparoscopy; blood loss was about 1000 ml.

Conclusion: According to the current literature, most cases of abdominal pregnancy are diagnosed intraoperatively. Lack of a standardized diagnostic algorithm is its contributing factor. The detection of abdominal pregnancy (especially in late gestation) during surgery is associated with technical and tactical difficulties for obstetricians and gynecologists, the need for emergency involvement of doctors of different surgical specialties and transfusion medicine specialists. The classification of reported cases of abdominal pregnancy in late gestation and their systematic analysis may help to standardize approaches to diagnosis and treatment, and reduce the risk of complications for both mother and fetus.