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Abdominal ectopic pregnancy.

Louise Dunphy1, Stephanie Boyle2, Nadia Cassim2

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Abdominal ectopic pregnancy (AEP) is a rare complication, often challenging to diagnose early. Prompt diagnosis using clinical suspicion, bHCG, and ultrasound is crucial for preventing severe maternal morbidity and mortality.

Keywords:
Emergency medicineObstetrics and gynaecology

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Area of Science:

  • Reproductive Medicine
  • Surgical Gynecology
  • Medical Diagnostics

Background:

  • Ectopic pregnancy (EP) affects 1-2% of pregnancies, with 90% in fallopian tubes.
  • Abdominal ectopic pregnancy (AEP) involves implantation outside the uterus or fallopian tubes, a rare EP variant (<1%).
  • AEP can be primary (fertilization in abdomen) or secondary (ruptured tubal EP), posing diagnostic challenges and risks.

Observation:

  • A multiparous woman in her early 30s presented with vaginal bleeding and abdominal pain at 8 weeks' gestation.
  • Elevated beta-human chorionic gonadotropin (bHCG) and ultrasound suggested EP; laparoscopy confirmed AEP on the pelvic sidewall.
  • Postoperative bHCG levels decreased, indicating successful management.

Findings:

  • Early AEP diagnosis is difficult and can be mistaken for tubal EP.
  • AEP diagnosed after 20 weeks carries high maternal-fetal mortality risk due to hemorrhage and coagulopathy.
  • Management includes surgical, medical (methotrexate, potassium chloride), or combined approaches.

Implications:

  • A high index of clinical suspicion is vital for early AEP diagnosis.
  • Correlating symptoms with bHCG and ultrasound findings is essential for timely diagnosis.
  • Prompt diagnosis and management of AEP are critical to prevent life-threatening complications.