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Primary Splenic Pregnancy: A Systematic Review of Published Case Reports
Goran Augustin1, Jure Krstulović2,3, Ante Krešo4
1Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia.
Journal of Clinical Medicine
|August 13, 2026
Summary
Primary splenic pregnancy (PSP) is a rare ectopic pregnancy. Diagnosis involves imaging and elevated hCG; management is typically surgical, with excellent maternal survival rates but rare spleen-preserving options.
Area of Science:
- Reproductive Medicine
- Surgical Gynecology
- Diagnostic Imaging
Background:
- Primary splenic pregnancy (PSP) is an exceptionally rare and potentially fatal form of ectopic pregnancy.
- Existing evidence is primarily based on isolated case reports, lacking comprehensive analysis.
- This study aims to consolidate and analyze the clinical characteristics, diagnostic approaches, treatment strategies, and patient outcomes of PSP.
Purpose of the Study:
- To systematically review and synthesize the available literature on primary splenic pregnancy.
- To elucidate the typical clinical presentations, diagnostic modalities, and management options for PSP.
- To assess maternal outcomes associated with primary splenic pregnancy.
Main Methods:
- A systematic literature review adhering to PRISMA 2020 guidelines was conducted.
- Searches were performed in PubMed, PubMed Central, and Google Scholar for cases of splenic pregnancy up to September 2025.
- Data extraction focused on clinical features, diagnostics, management, and outcomes, with inclusion of primary splenic pregnancy and exclusion of secondary cases.
Main Results:
- Sixty cases of primary splenic pregnancy were identified, with a mean maternal age of 30.3 years, predominantly reported in Asia.
- Abdominal pain (86.7%), often left upper quadrant, was the most frequent symptom; hypotension and hemoperitoneum occurred in 41.7% and 60.0% of cases, respectively.
- Ultrasound was the primary imaging tool, with CT and MRI showing high diagnostic accuracy; surgery (90%), mainly laparotomy with splenectomy, was the standard treatment, yielding nearly universal maternal survival.
Conclusions:
- Primary splenic pregnancy should be considered in cases of left-sided abdominal pain with intra-abdominal bleeding, an empty uterus, and elevated human chorionic gonadotropin (hCG).
- Management requires individualization based on clinical status, imaging, and surgical expertise, as no reliable hCG threshold for treatment selection is established.
- While maternal survival is high, spleen-preserving and non-surgical treatments for PSP remain uncommon.