Abdominal ectopic pregnancies are an extremely rare type of ectopic pregnancy.
They are thought to represent ~1% of all ectopic pregnancies 6 with an estimated incidence of 1:1000-10,000 births.
It is often thought that they most frequently result from a tubal rupture with subsequent reimplantation of the conceptus onto bowel, omentum or mesentery (in very rare situations primary abdominal ectopic may also occur). Uncommon cases when it develops as a result of a scar rupture have also been reported 3.
It typically develops around the ligaments of the ovary, on the uterus or in the pouch of Douglas, although it can implant anywhere within the abdominal cavity. It can then obtain blood supply from the omentum and abdominal organs. At times these pregnancies migrate out of the pelvis and are seen in the upper abdomen. The placental attachment can also be at unusual sites including the anterior abdominal wall 7.
- previous tubal damage
- pelvic inflammatory disease
- IVF 8
- presence of an intrauterine device 9
Ultrasound is often at the frontline of imaging. Sonographically the pregnancy is seen separate from the uterus, adnexa, and ovaries.
May have a role in better delineation of anatomy and relationships especially when the pregnancy is advanced.
Treatment and prognosis
It is a serious and potentially life-threatening condition. Maternal mortality associated with intra-abdominal pregnancy is estimated at 7.7 times that of other locations of ectopic pregnancy 6, with a mortality rate of ~5% 8.
Treatment is by often by means of placental embolisation followed by a laparotomy or laparoscopy. While an abdominal pregnancy can result in a life-threatening emergency, especially when diagnosed late in gestation, it can also result in a live birth by means of a laparotomy 1.
- intra-abdominal haemorrhage with massive haemoperitoneum
- 1. Levine D. Ectopic pregnancy. Radiology. 2007;245 (2): 385-97. doi:10.1148/radiol.2452061031 - Pubmed citation
- 2. Williams CH. Ultrasound evaluation of a near-term abdominal ectopic pregnancy. J Clin Ultrasound. 1978;6 (4): 264-5. - Pubmed citation
- 3. Teng HC, Kumar G, Ramli NM. A viable secondary intra-abdominal pregnancy resulting from rupture of uterine scar: role of MRI. Br J Radiol. 2007;80 (955): e134-6. doi:10.1259/bjr/67136731 - Pubmed citation
- 4. Harris MB, Angtuaco T, Frazier CN et-al. Diagnosis of a viable abdominal pregnancy by magnetic resonance imaging. Am. J. Obstet. Gynecol. 1988;159 (1): 150-1. - Pubmed citation
- 5. Malian V, Lee JH. MR imaging and MR angiography of an abdominal pregnancy with placental infarction. AJR Am J Roentgenol. 2001;177 (6): 1305-6. AJR Am J Roentgenol (full text) - Pubmed citation
- 6. Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics. 2008;28 (6): 1661-71. doi:10.1148/rg.286085506 - Pubmed citation
- 7. Zaki ZM. An unusual presentation of ectopic pregnancy. Ultrasound Obstet Gynecol. 1998;11 (6): 456-8. doi:10.1046/j.1469-0705.1998.11060456.x - Pubmed citation
- 8. Dibble EH, Lourenco AP. Imaging Unusual Pregnancy Implantations: Rare Ectopic Pregnancies and More. AJR Am J Roentgenol. 2016; 1-13. doi:10.2214/AJR.15.15290 - Pubmed citation
- 9. Agarwal N, Odejinmi F. Early abdominal ectopic pregnancy: challenges, update and review of current management. The Obstetrician & Gynaecologist 2014;16:193–8.
Related Radiopaedia articles
First trimester of pregnancy
- ultrasound findings in early pregnancy
- confirming intrauterine gestation
- pregnancy of unknown location (PUL)
first trimester vaginal bleeding
- ectopic pregnancy
failed early pregnancy
- pregnancy of uncertain viability (PUV)
- anembryonic pregnancy
- yolk sac abnormalities
- gestational trophoblastic disease
- subchorionic haemorrhage
- demise of a twin
- implantation bleeding
- aneuploidy testing
Ultrasound - obstetric
- ultrasound (introduction)
- obstetric ultrasound
first trimester and early pregnancy
- gestational sac
- yolk sac
- Beta-hCG levels
- ectopic pregnancy
- multiple gestations
- subchorionic hematoma
- failed early pregnancy
- fetal biometry
- fetal morphology assessment
- fetal echocardiography views
- nonvisualisation of the fetal stomach
- nuchal fold thickness
- absent nasal bone
- choroid plexus cysts
- enlarged cisterna magna
- shortened fetal long bones
- echogenic intracardiac focus (EIF)
- echogenic fetal bowel
- aberrant right sublavian artery
- fetal pyelectasis / fetal renal pelvic dilatation
- single umbilical artery
- sandal gap toes
- Doppler ultrasound
- umbilical artery Doppler assessment
- fetal middle cerebral arterial Doppler assessment
- ductus venosus flow assessment
- umbilical venous flow assessment
- nuchal translucency
- 11-13 weeks antenatal scan
- chorionic villus sampling (CVS) and amniocentesis
- first trimester and early pregnancy