Primary abdominal pregnancy. A case report

Abdominal pregnancies are very uncommon; in the United States they are seen once every 10,000 births and consist of approximately 1% ectopic gestations. We report one case with a primary pelvic-peritoneal ectopic pregnancy, diagnosed by chance at 11 gestational weeks complicated by hemoperitoneum and acute abdomen. This case is interesting because the early diagnosis of abdominal pregnancy is frequently difficult. In fact the clinical history, physical examination, laboratory and ultrasonographic findings are non specific. The physical examination is inconclusive in most patients. Findings such as abdominal tenderness, a closed uneffaced cervix, palpation of a pelvic mass distinct from the uterus are described as being suggestive of the abdominal pregnancy. Once the diagnosis of abdominal pregnancy is made, management of these patients requires a careful and further evaluation. Most clinicians agree that immediate operative intervention is indicated for those pregnancies prior to 23 to 24 weeks, because of the high incidence of maternal morbidity with significant risks of maternal mortality, in light of the poor prognosis for the fetus. In patients who present after 24 weeks, debate has arisen in the literature concerning the appropriateness of a more conservative approach.