Abdominal pregnancies represent only one percent of all ectopic pregnancies. Most cases of abdominal pregnancy occur from an undetected ruptured tubal pregnancy that implants itself in the abdominal cavity. Occasionally, an ovum may be fertilized outside the fallopian tubes and go on to implant in the areas of the abdominal cavity. It may, very rarely, also happen due to uterine rupture. The foetus may implant on the peritoneum, which is a continuous thin sheet of tissue, or membrane, which lines the cavities of the abdomen and pelvis, and covers the surfaces of the organs found within. The growing placenta may be attached to the tubes, ovaries, the intestines and rarely to the liver and the spleen.
An abdominal pregnancy has few symptoms. Most of them are common to other types of complications as well. It is difficult to diagnose an abdominal pregnancy therefore, and it may remain undetected until late in the pregnancy. It is usually suspected to be an abdominal pregnancy when the baby’s parts can be easily felt, the lie or position of the baby is persistently abnormal, the cervix is displaced, the uterus is ill-defined and failure of induction of labour .
Diagnosis of an abdominal pregnancy is usually done by ultrasound. However, a less skilled operator may miss to see the signs of an abdominal pregnancy. Some of the signs that there is an abdominal pregnancy are: the pregnancy is outside an empty uterus, there is reduced to no amniotic fluid between the placenta and the foetus, there is no uterine wall surrounding the foetus, foetal parts are close to the abdominal wall, the placenta looks abnormal and there is free fluid in the abdomen. MRI and laparoscopic surgery can also be used to diagnose abdominal pregnancy.
Treatment of abdominal pregnancy is ideally surgery and termination of the pregnancy. In cases where some pre-defined criteria are met, such as the foetus is alive, without deformation etc. conservative treatment is also possible and the foetus may be carried to term. The choice is made depending on the situation.
A woman with abdominal pregnancy will not go into labour. Delivery in such cases is done surgically. Infant mortality rate is high in full term abdominal pregnancies. Such babies also have a high rate of deformations owing to the fact that there is no protective uterine wall or amniotic fluid around them. Removal of the placenta is difficult in abdominal pregnancies because it may cause excessive blood loss. In an intra-uterine pregnancy, the strong uterine contractions stop the blood flow. In an abdominal pregnancy, the placenta is attached to tissues in the abdomen and controlling blood flow after removing the placenta is a challenge. Blood transfusion is common during the delivery in such pregnancies.
Though deemed dangerous for both mother and baby, there are several reports of such pregnancies being managed successfully and resulting in healthy babies. It is important to research and be alert to symptoms, and contact the healthcare practitioner in case of the slightest concern.