Advanced abdominal ectopic pregnancy: Utility of MRI for operative planning

Advanced abdominal pregnancy (AAP) is a rare and potentially life-threatening form of ectopic pregnancy. We report the case of a 33-year-old woman, G2P0010, who presented with progressive abdominal pain and distension found to be 30 weeks and 1 day of gestation by ultrasound biometry. Ultrasound demonstrated an abdominal pregnancy with fetal demise and MRI confirmed an extrauterine fetus within the peritoneal cavity, an empty uterus, and a placenta extending from the mid-abdomen into the pelvis with mass effect on the sigmoid colon, without definite bowel invasion. Surgical exploration confirmed the MRI findings; the placenta was adherent to the rectosigmoid colon and left ovary but was removed without bowel resection, with ovarian preservation. This case highlights the utility of MRI in confirming AAP, mapping placental implantation, and guiding preoperative surgical planning.