Magnetic resonance imaging-guided surgical strategy for secondary abdominal pregnancy implanted in the broad...

Secondary abdominal pregnancy implanted in the broad ligament poses a high risk of catastrophic hemorrhage because of complex parametrial vascularization. Optimal surgical planning is therefore critical. A 28-year-old primigravida at 13 weeks' gestation was diagnosed with secondary abdominal pregnancy at Gansu Provincial Maternity and Child Care Hospital in October 2023. Pelvic magnetic resonance imaging precisely delineated placental attachment to the posterior leaf of the left broad ligament and identified adjacent hypervascular parametrial structures. Based on the imaging findings, a hemorrhage-control-oriented surgical plan was developed. Exploratory laparotomy enabled stepwise devascularization, controlled blunt placental dissection, and selective salpingectomy. Total intraoperative blood loss was limited to 50 mL. Serum human chorionic gonadotropin normalized within 2 weeks. No complications occurred. Magnetic resonance imaging-based preoperative vascular mapping enables tailored surgical planning and minimizes hemorrhagic risk in patients with broad ligament abdominal pregnancy. Structured placental management with controlled blunt dissection may represent a feasible surgical approach.