Abdominal pregnancy is one of the rarest types of ectopic pregnancy. About 1% of ectopic pregnancies in the United States are abdominal (10 out of every 100,000 pregnancies) . The importance of such variety is not only related to the rarity of the diagnosis but also for the seriousness of its sequels; the maternal mortality rate is estimated to be about 5 per 1,000 cases, about seven times the rate for ectopic pregnancy in general, and about 90 times the rate for a normal delivery . The term advanced abdominal pregnancy refers to pregnancy with a gestational age beyond 20 weeks with a living fetus or one that has shown signs of life with the entire progress inside the abdominal cavity . Though very rare, delivery of a term living abdominal pregnancy has been reported. However, more than 90% of the survivors have serious malformations .The Diagnosis of abdominal pregnancy may be more difficult than classic tubal pregnancy. Ultrasonography of both abdominal and transvaginal scanning combined with ß HCG estimation has made early diagnosis . More recently combined ultrasonography and Magnetic Resonance Imaging (MRI) is emphasized for accurate diagnosis of late abdominal pregnancy cases.
A twenty-two years old woman, G2P0+1, pregnant ± 30 weeks based on a reliable dating of last menstrual period presented to Women’s Health Hospital outpatients’ clinic ,with abdominal pain and absent foetal movements for 7 days. She described pain as being diffuse non-radiating, located in the left hypochondrial fossa, of gradual onset, and with no relieving factors. She gave no history of vaginal bleeding or discharge. The patient has been married for 6 years during which she had a single first trimester miscarriage (8 weeks) 5 years prior to this pregnancy; this miscarriage was spontaneous and uncomplicated. It was followed by a period of infertility during which she received repeated courses of induction of ovulation. She had regular antenatal visits in which ultrasound scanning being performed about three times. First scan was in the first trimester, and she was told that her baby is doing well, However during her last antenatal visit her physician noticed markedly decreased or rather completely absent amniotic fluid around the fetus who was in transversely lie with good fetal heart rate.
On examination, the patient was conscious with stable vital signs. Abdominal examination revealed tenderness on the left hypochondrial region and easily palpable fetal parts .The pelvic examination revealed a well-formed firm cervix.
Abdominal ultrasound scan revealed an empty uterus with extrauterine placenta adherent to the fundus of the uterus. A thirty weeks fetus in left hypochondrial region also was detected. An advanced extrauterine pregnancy was suspected; MRI was done and confirmed data in the ultrasound report. The patient was scheduled for laparotomy two days after admission to the hospital and corticosteroid was give.