Pregnancy, Intra-Abdominal

Incidence in USA: 11:100,000 live births and 9:1000 ectopic pregnancies.

Higher incidence in African Americans, Asians, and immigrant populations from third-world countries.

Risk factors include PID, tubal damage, intrauterine contraceptive devices, assisted reproductive techniques, previous ectopic, and previous pelvic surgery.

Maternal mortality 100 times that of intrauterine pregnancy.

Perinatal mortality ranges from 40–95%.

Misdiagnosis prior to delivery is not uncommon, and a high index of suspicion is important for Dx. In one case series, only 6 of 10 pts were diagnosed preop.

Massive hemorrhage may occur anytime in the periop setting.

Severe hemorrhage depending on location of placental implantation in the abdomen.

Decreased placental perfusion and oligohydramnios, leading fetal growth restriction, pulmonary hypoplasia, and anatomic deformities.

Defined as implantation in the peritoneal cavity, not including the fallopian tubes, ovaries, or ligaments.

Early pregnancy may be normal and subsequently presenting with midtrimester abdominal pain, N/V, shock, partial bowel obstruction, and vaginal bleeding.

Differential Dx includes abruptio placentae, placenta previa, uterine rupture, pelvic inflammatory disease, and bowel obstruction. MRI is better than US diagnosis. US may miss diagnosis in >50% of cases.

Exsanguinating intraabdominal bleeding can occur at any time.

No abnormal trend in serial hCG values compared to that seen in tubal pregnancies.