Early primary abdominal pregnancy: Diagnosis and management. A case report

Abdominal pregnancy is a rare type of ectopic pregnancies associated with a high mortality rate. Symptoms are not specific and usually resemble the other types of ectopic pregnancies. Medical management is used in cases where a potentially lethal hemorrhage can be anticipated. Nowadays, laparoscopic surgery has become the most common choice especially in cases diagnosed during the first trimester.

A 35-year-old woman consulted for a pelvic pain and menstruation delay. She had a stable hemodynamic status and hypogastric tenderness during deep abdominal palpation. The βHCG rate was at 16041 IU/l. Pelvic ultrasonography revealed a gestational sac next to the right adnexa of 1.2 cm. Laparoscopic exploration was performed finding normal fallopian tubes and ovaries with a 2 cm mass on the vesical peritoneum. Resection of ectopic pregnancy was successfully performed and patient was discharged the next day with no postoperative complications.

To date, there is no therapeutic protocol that has been established and there are no predictive criteria of success concerning medical management for ectopic pregnancy. Surgery is the most common choice in the therapeutic management of ectopic abdominal pregnancy. Laparotomy was preferred to the laparoscopic surgery because of the high risk of perioperative hemorrhage which can be uncontrollable from the implantation site. Nowadays, laparoscopic surgery should be the first measure if the abdominal pregnancy is diagnosed at an early stage (< 12 weeks) or if the implantation site allows a non-hemorrhagic surgical excision.

Laparoscopic management of abdominal pregnancies is an encouraging choice to laparotomy.