Key content
Early abdominal ectopic pregnancy (EAP), though rare, has a high mortality rate.
There are no pathognomic symptoms of abdominal pregnancy. Symptoms are akin as for other types of ectopic pregnancy, thus a high index of suspicion is necessary
for diagnosis.
The tool of choice for diagnosis is ultrasound but it only gives 50% accuracy when used along with clinical evaluation. On occasion,magnetic resonance imaging may help to diagnose EAP.
Medical management is commonly used where potential life-threatening bleeding is anticipated. A number of women who are treated medically may need subsequent treatment with
multiple therapies.
Surgical management requires a great deal of surgical expertise and in most cases a multidisciplinary approach in anticipation of possible life-threatening bleeding during the operation.
Learning objectives
 To outline the classification of EAP.
To understand the common risk factors associated with EAP.
To understand how to diagnose EAP.
To be aware of the different medical and surgical management of EAP and the ethical issues associated with diagnosis and treatment.
Ethical issues
 Distinguishing an abdominal pregnancy from the more common variants of ectopic pregnancy remains difficult and a definitive diagnosis is usually made at surgery.
There is no established guidance available for the diagnosis and management of EAP.
 Many EAP are never diagnosed because of a successful response to medical management for a pregnancy of unknown location.
 As it is not uncommon to diagnose EAP for the first time during surgery, the difficulties in diagnosis prior to surgery means that patients require life-saving surgery beyond the scope of the
preoperative signed consent form.

Introduction

Incidence

Classification of abdominal pregnancy

Risk factors

Diagnosis

Pathophysiology

Treatment

Medical management

Surgical management

Conclusion
EAP is rare, and successful management depends on a high index of suspicion. While ultrasound and serial human chorionic gonadotrophin may help in the diagnosis, there is no single diagnostic tool available.

At laparoscopy it is important that if an ectopic pregnancy is not visualised in the usual locations, then all of the abdominal cavity is inspected to include all abdominal organs. If the diagnosis is still not confirmed then MRI or intraoperative ultrasound may assist in diagnosis.