What Is an Abdominal Pregnancy?

Abdominal pregnancy is a life-threatening ectopic pregnancy where the embryo or fetus grows and develops in the peritoneal cavity instead of typically developing in the uterus of the female body. It is a rare phenomenon and can evolve full-term if not recognized during the early stages of pregnancy. Abdominal pregnancy is risky for both the mother and fetus. Researchers have observed the chances of ectopic abdominal pregnancy to be 7.7 times more than ectopic pregnancy in other areas of the posterior cavity, with a 40% risk of fetal malformations having a survival rate of 50% up to a week after delivery.

How does it Happen?

The uterus lies between the urinary bladder and the rectum and is the place for fetal development after successful fertilization. During pregnancy, the uterus undergoes several changes, like thickening its lining, enlarging its blood vessels, and expanding to feed and nurture the baby. In most cases, after fertilization in the fallopian tube that links the ovary to the fetus, the egg successfully travels down the fallopian tube and implants in the uterus.

Complications occur when the egg grows outside the uterus and, in case of abdominal pregnancy, in the peritoneal cavity ( the area in the abdomen containing the stomach, liver, and intestines ). The symptoms of abdominal pregnancy are not specific and usually resemble that of other ectopic pregnancies.

While reviewing 5221 cases of abdominal ectopic pregnancies, researchers found a 5.1 mortality per 1000 cases, with a higher occurrence in countries with lower socioeconomic status and in people using assisted reproductive technology to get pregnant. Some of the most common areas of abdominal pregnancy in the body have been observed to be

• Recto-uterine pouch or lowest point of the abdominal cavity

• Vesico-uterine pouch or the fold of the peritoneum between the uterus and the bladder

• Uterine Serosa in the region outside the uterus and near the abdomen.

Types of Abdominal Pregnancy

Depending on the factors leading up to the pregnancy, abdominal pregnancy can be either

Primary Abdominal Pregnancy

Primary Abdominal Pregnancy occurs when the blastocyst ( early stage of the embryo) is implanted inside the peritoneal cavity. Physicians classify abdominal pregnancy to be primary if

• Both tubes and ovaries are in normal condition without any signs of injury

• There is no evidence of utero-peritoneal fistula

• The pregnancy is early and related exclusively to the peritoneum of the body

Secondary Abdominal Pregnancy

Secondary Abdominal pregnancy occurs when the embryo is implanted inside the tube, uterus, or ovary but later migrates out because of uterine complications and is implanted in the peritoneal cavity. Some of the causative factors behind secondary abdominal pregnancy are

• The uterine rupture that occurs when the uterus breaks or tears open

• Uterine Rudimentary horn ( uterine anomaly ) rupture

• Fimbrial (ectopic tubal pregnancy)Abortion

Symptoms

Abdominal pregnancy is referred to as Early when the term is 20 weeks of amenorrhea or missed periods and Advanced when the term has exceeded 20 weeks. Some of the chief symptoms of abdominal pregnancy are

• Abdominal Pain

• Nausea

• Vomiting

• Pain in fetal movement

• Palpable fetal parts

Some of the symptoms of secondary abdominal pregnancy are

• Spotting or Irregular bleeding with abdominal pain

• Nausea and Vomiting

• Flatulence

• Constant abdominal pain

• Observed in varying degrees. The problems can, in turn, result in serious complications like

• Fetal malpresentation or unusual position of the baby

• Extreme anterior displacement of the cervix or its tilting towards one side

• Failure of spontaneous onset of labor

• Artificial induction of labor

• Cervix Effacement difficulties leading to labor difficulties

Diagnosis

Some of the chief methods by which medical professionals diagnose abdominal pregnancy are

Ultrasound

Two types of ultrasounds are advised to diagnose abdominal pregnancy.

Abdominal Ultrasound

In which the ultrasound is applied to the abdomen externally

Transvaginal Ultrasound

When the ultrasound is inserted into the vagina for a sharper and clearer image

Laboratory Tests

Blood tests and human chorionic gonadotropin are some lab tests your physician will advise when diagnosing abdominal pregnancy.

MRI

Physicians recommend MRI when

• They cannot visualize the uterine wall around the fetus

• Empty uterus

• Abnormal placenta formation

CT Scanning

Several medical professionals use Contrast-Enhanced CT scans to accurately differentiate whether the pregnancy is abdominal or tubal.

Management

Surgery is the most common treatment in abdominal pregnancy, as left untreated, it can result in severe hemorrhage and prove risky to the mother. Laparotomy and Laparoscopy are the standard management methods keeping in mind the fetus's gestational age while diagnosing it.

Conclusion

Abdominal pregnancy is often left undetected or misdiagnosed as an intrauterine pregnancy because of the location of ectopic pregnancy and the lack of experienced medical personnel to perform the diagnostic tests. In such conditions, awareness about the situation and strengthening your core muscles when pregnant can help to detect and prevent it.