Advanced abdominal pregnancy secondary to tubal pregnancy: a rare case report and literature review

A pregnant woman was found to have a left tubal pregnancy on transabdominal ultrasound (9 weeks 5 days by CRL). However, she refused any treatment and left the hospital. Nearly 3 months later, this woman was admitted to the emergency room due to severe abdominal pain. The emergent ultrasound scan revealed an abdominal ectopic pregnancy at 22 weeks’ gestation. The placenta covered the left abdominal wall and was implanted into the omentum, intestinal wall, and bladder wall. Magnetic resonance imaging (MRI) confirmed the diagnosis. The location and relationship of the placenta to its adjacent organs were delineated on the abdominal surface based on ultrasound findings. On the third day of admission, a laparotomy was performed and the fetus was delivered (Apgar score 3). The placenta was detached and removed without any complications. Advanced abdominal pregnancy (AAP) is rare and severe ectopic pregnancy, defined as intraperitoneal pregnancy excluding tubal, ovarian, or intraligamentous pregnancy, progressing beyond 20 weeks of gestation. Monitoring the whole development process from a tubal pregnancy to AAP, with a viable fetus, is much rarer. Therefore, we present this case, review the literature on AAP, and summarize its characteristics as well as management. Ultrasound and MRI are vital for improving outcomes in AAP, which remains a potentially life-threatening condition. Ultrasound and MRI should be used to confirm the location of the gestational sac in relation to the endometrial cavity and the placenta in relation to abdominal organs. Accurate diagnosis and appropriate multidisciplinary team (MDT) management can lead to favorable outcomes.