Challenging Diagnosis of Late Abdominal Pregnancy: A Case Study of Misdiagnosis and Fetal Death in the Third Trimester.

BACKGROUND Abdominal pregnancy is a rare form of extrauterine pregnancy that usually results in a poor outcome; it is associated with serious fetal and maternal morbidity. The diagnosis of advanced abdominal pregnancy is sometimes challenging and should be identified early, at a routine antenatal examination. There are still no evidence-based management strategies for late abdominal pregnancy. This report presents a case of a patient with an abdominal pregnancy and a non-viable fetus. CASE REPORT A 34-year-old woman presented as an emergency 2 months after the diagnosis of intrauterine fetal death at 33 weeks of gestation. During subsequent surgery, the pregnancy was found to be an undiagnosed abdominal pregnancy. The patient had been admitted due to abdominal pain and increasingly deteriorating general condition. On admission, clinical examination and abdominal ultrasound were carried out and the diagnosis of fetal death was confirmed. The diagnosis of extrauterine pregnancy, however, was initially missed, and a decision to induce labor was made. After unsuccessful induction of labor and deterioration of the patient's general condition, a laparotomy was performed, and the diagnosis of abdominal pregnancy was confirmed. A severely macerated fetus and placenta were delivered. Relative to others with this condition, the patient had a very good postoperative outcome with prolonged healing of the surgical incision. Informed consent for publication was obtained from the patient. CONCLUSIONS The diagnosis of late abdominal pregnancy can be missed despite clinical and sonographic examination. This diagnosis should be considered and excluded in similar suspected clinical findings. Proper operative planning in a tertiary center with a well-experienced team is crucial.

Omentum pregnancy resulting in severe hemoperitoneum: Lessons learned from a review of the literature along with a case report.

Abdominal pregnancies are a rare form of ectopic pregnancy with omentum pregnancies being even rarer. Ectopic pregnancy should be diagnosed and terminated early to prevent the risk of harm to the mother. This case report describes a rare case of omentum pregnancy with severe hemoperitoneum. The patient had not visited a doctor until she failed to menstruate for 3 months, by which point she had developed severe hypogastralgia. The patient was diagnosed with a ruptured ectopic pregnancy after ultrasonography. The omentum pregnancy was complicated by severe hemoperitoneum, which was confirmed by emergency laparotomy. The patient was treated successfully with fetal extraction and partial omentectomy. Ultrasound examination in early pregnancy is essential to detect and treat ectopic pregnancies as early as possible, as surgery is usually required for abdominal pregnancies. Prompt treatment of ectopic pregnancies is critical, as an omentum pregnancy is dangerous and may result in severe intraperitoneal bleeding.

Primary omental pregnancy after in vitro fertilization complicated by hemoperitoneum-how to manage it laparoscopically.

OBJECTIVE: To report an uncommon case of primary OP treated laparoscopically. Ectopic pregnancy (EP) is the leading cause of maternal mortality during the first trimester and the incidence increases with assisted reproductive techniques, occurring in approximately 1.5%-2.1% of patients undergoing in vitro fertilization.1 Omental pregnancy (OP) is an extremely rare form of EP accounting for less than 1% of all EPs. OP can be classified as primary or secondary on the basis of Studdiford's criteria2. The preoperative diagnosis of OP is complex and usually occur in acute circumstances during a throughout intraoperative evaluation of the abdomen.3-5 A delayed diagnosis poses a serious threat to the survival of the patient; therefore, it is important to remark that EP can exist in unusual locations and prompt surgical intervention may be necessary. DESIGN: A step-by-step narrated video of a rare clinical case and description of the surgical procedure. SETTING: Tertiary Level Academic Hospital "IRCCS Azienda Ospedaliero - Universitaria di Bologna" Bologna, Italy. PATIENT: A 36-year-old woman was referred to our emergency room because of acute abdominal pain and nausea for 2 hours with no signs of hemodynamic instability. The patient also complained that poor vaginal bleeding appeared during the last 24 hours. The patient has undergone a cycle of in vitro fertilization with an elective single frozen embryo transfer of a blastocyst on day 5, 2 months before. She had no relevant clinical or surgical history. Diffuse abdominal tenderness and a painful uterus at mobilization were appreciated at clinical examination. A massive hemoperitoneum was diagnosed using transvaginal-transabdominal ultrasound, and no uterine or adnexal lesions were identified. The ß-human chronic gonadotropin level was 43.861 mIU/mL, and the hemoglobin value was 10.5 g/dL. INTERVENTIONS: On suspicion of a ruptured EP, after detailed counseling and the acquisition of informed consent, a laparoscopic exploration was planned. First, the hemoperitoneum was evacuated to allow visualization of the abdominal cavity. At pelvic inspection, no EP was found. Throughout the exploration of the abdominal cavity, a 4-cm bluish cystic mass of friable consistency was detected infiltrating the omentum and the mesentery. According to Studdiford's criteria, the diagnosis of a primary OP was established. A careful and complete excision of the ectopic implant was performed with an ultrasonic system and required a considerable hemostatic effort using bipolar energy, endoscopic clips, and mechanical compression. The postoperative course was uneventful. The ß-human chronic gonadotropin levels gradually decreased to negative values within 29 days after surgery. MAIN OUTCOME MEASURE(S): Omental ectopic pregnancy can be successfully managed with a laparoscopic approach even in an emergency setting. CONCLUSION: Omental pregnancy can easily be overlooked, even by skilled surgeons, during laparoscopic exploration. It is mandatory that all peritoneal surfaces and the omentum be carefully inspected during surgery in patients without other signs of pelvic EP.We confirm that the patient included in this video gave consent for publication of the video and posting of the video online, including on social media, the journal website, scientific literature websites, and other applicable sites.

Pregnancy in Morrison Pouch: a case report.

Abdominal pregnancy is a rare form of ectopic pregnancy (accounting for 1% of all ectopic pregnancies). Depending on gestational age and its location various symptoms and signs may be exhibited. This study aimed to report a case of abdominal pregnancy occurring in the Morrison Pouch with a primary presentation of right upper quadrant pain and to highlight complications that may arise in the management of abdominal pregnancy located in the Morrison Pouch. A 22-year pregnant woman at gestation of 22 weeks presented with a right upper quadrant mass and pain. Ultrasound examination revealed a live extrauterine singleton at Morrison Pouch, full blood count showed severe anemia. The patient received a blood transfusion in seven days and underwent emergency laparotomy after experiencing sudden acute internal hemorrhage but died a few hours post laparotomy due to hemorrhagic shock. Abdominal pregnancy carries a high risk of maternal hemorrhage as described in this case.

Successful laparoscopic resection of retroperitoneal ectopic pregnancy between the abdominal aorta and inferior vena cava: A case report.

Retroperitoneal ectopic pregnancies are extremely rare; only a few cases having been reported. Here, we report laparoscopic removal of an asymptomatic retroperitoneal ectopic pregnancy from a 29-year-old woman who was referred to our hospital for a suspected ectopic pregnancy. Transvaginal ultrasound did not reveal a gestational sac in the uterus or pelvic cavity. However, abdominal contrast-enhanced computer tomography showed a gestational sac between the abdominal aorta and inferior vena cava. On laparoscopy, the gestational sac was confirmed to be in this retroperitoneal location and successfully removed with minimal bleeding. Histopathologic examination revealed chorionic villi surrounded by lymphatic tissue, suggesting lymphatic spread of the retroperitoneal ectopic pregnancy. In summary, contrast-enhanced computer tomography is very useful for locating the site of pregnancy in women suspected of having a retroperitoneal ectopic pregnancy. Timely diagnosis of a retroperitoneal ectopic pregnancy before bleeding occurs can enable their safe laparoscopic removal.

Prolonged abdominal pregnancy incidentally discovered during cesarean section: a case report.

BACKGROUND: Abdominal pregnancy is a rare medical condition that is still missed in developing countries due to inadequate medical facilities. The clinical indicators manifest in various forms and are nonspecific, making it challenging to diagnose and often leading to delayed detection. However, obstetric ultrasound serves as an essential tool in early detection. Our objective was to share our experience dealing with this condition and emphasise the importance of early ultrasound diagnosis through efficient pregnancy monitoring in our regions. CASE PRESENTATION: 35-year-old Black African woman who had ten months of amenorrhea sought consultation due to an absence of active foetal movements. Her pregnancy was of 39 weeks with fetal demise which was confirmed following clinical examination and ultrasound. She underwent cesarean section in view of transverse position of fetus. During cesarean section, the fetus was found within the abdominal cavity with the placenta attached over the left iliac fossa including surface of left ovary. The uterus and right adnexa were within normal limits. A 2600 g macerated fetus with placenta and membranes were extracted without any complications. The maternal outcome was successful. CONCLUSIONS: Abdominal pregnancy remained an inadequately diagnosed condition in developing countries. It is imperative to increase awareness among pregnant women regarding high-quality prenatal care, including early obstetric ultrasound, from conception. Meanwhile, healthcare professionals should receive continuous training and the technical platform modernised. To ensure accurate diagnosis, the location of the gestational sac must be identified for every pregnant woman during their initial ultrasound appointment.

Unrecognized abdominal pregnancy with six months' evolution revealed by acute intestinal obstruction in women with PCOS.

Abdominal pregnancy is a rare form of ectopic pregnancy where implantation and development of the egg take place in the peritoneal cavity outside the tubo-uterine mucosa, in contact with intestinal loops. Diagnosis is most often difficult. We report the case of a 32-year-old woman (gravida 1, para 1), with a history of PCOS, diagnosed with abdominal pregnancy at 20 weeks of amenorrhea complicated by acute intestinal obstruction. Diagnosis was confirmed by abdomino-pelvic scan. Surgery was performed with the patient under general anesthesia. She presented a macerated fetus with an infiltration of the placenta causing a perforation of the sigmoid colon and uterus. Hartmann's procedure was performed and the perforation of the uterus was sutured. Abdominal pregnancy remains a rare variety of ectopic pregnancy. Preoperative diagnosis is difficult due to the presence of a variety of non-specific symptoms. This type of ectopic pregnancy remains challenging for gynecologists and radiologists.

Non-tubal ectopic pregnancy treatment experiences of a tertiary care center.

AIM: To evaluate the incidence, the risk factors, and the treatment outcomes of Non-tubal ectopic pregnancies (NTEP) treated in a tertiary care center. MATERIAL AND METHODS: A total of 110 NTEP cases treated between 2014 and 2019 were included in the retrospective study. The study cohort was divided into 6 groups according to the pregnancy localization: 87 cesarean scar pregnancies (CSPs), 7 ovarian pregnancies, 6 interstitial pregnancies, 4 rudimentary horn pregnancies, 4 abdominal pregnancies, and 2 cervical pregnancies. One woman rejected all treatment modalities. Demographic characteristics, treatment modalities, and outcomes of each group were evaluated. RESULTS: In the study cohort, expectant management was performed in one (0.9%) woman. The methotrexate (MTX) treatment was administered in 29 (26.3%) women. Seventeen (15.4%) women underwent surgery, and 63 (57.2%) women underwent manual vacuum aspiration (MVA). A woman rejected all treatment modalities. Although 70.1% (n = 61) of CSPs were cured with MVA, 24.1% (n = 21) of them were treated with a single-dose MTX regimen in addition to MVA. The higher mean gestational sac size (33,9 ± 12,96 mm vs. 17,34 ± 9,87 mm), the higher mean gestational week (8,43 ± 1,16w vs. 6,66 ± 1,49w), the presence of fetal heartbeat (FHB) (90.5% vs. 26,2%) and the history of pelvic inflammatory disease (PID) (38.1% vs. 6,6%) were found in the CSPs with MVA treatment failure (p < 0.05). CONCLUSION: The management of NTEPs should be individualized according to the clinical and ultrasonographic findings. The size of the ectopic pregnancy mass, the gestational week, the presence of FHB, and the PID history were the predictive factors for the failure of MVA in CSP cases.

Chronicles of an uncommon term abdominal pregnancy with successful outcome: a case report.

BACKGROUND: Intra-abdominal pregnancies, while rare, present with unique diagnostic and management challenges. We present a case of a 25-year-old para 2 + 1, black African woman, who was referred from a peripheral Health Centre level IV in the Northern part of Uganda to a Regional Referral Hospital due to an abnormal presentation with easily palpable fetal parts. This case emphasizes the significance of prompt diagnosis, interdisciplinary collaboration, surgical planning, and managing the placenta in advanced intra-abdominal pregnancies. CASE PRESENTATION: A 25 year African black female, para 2 + 1 upon arrival at Regional Referral Hospital, a University Teaching Hospital during a weekend, an ultrasound was sourced from a nearby private clinic revealing an extra-uterine intra-abdominal pregnancy at 38 weeks of gestation and she was promptly sent back to the University Teaching Hospital. Following this diagnosis, the patient, who hailed from a remote village over 30 km away, returned to her family for discussions. After three days, she was readmitted. Emergency laparotomy unveiled an omental gestation sac with extensive placental attachment. A live female infant was delivered successfully, placenta was left in situ. The postoperative course was uneventful, with initial concerns about inadequate breast milk flow which resolved after placental removal during the second exploratory laparotomy. CONCLUSION: This case highlights the uncommon occurrence of an advanced intra-abdominal pregnancies and emphasizes the importance of multi-disciplinary teamwork and placental management. The favorable outcome in the management was based on thorough assessment of the placental location, attachments and blood supply during surgery. It demonstrates the possibility of reduced risk of massive bleeding if there is a delayed removal of placenta with favorable attachment. This is particularly important for milk letdown as well as reducing the needs of blood transfusion in resource limited settings.

Broad ligament ectopic pregnancy at 18 weeks: diagnosis and management in a resource-limited setting (a case report).

Broad ligament ectopic pregnancy is a relatively rare condition described in the literature. We did not find enough data concerning this subject in Cameroon. It is therefore important to know about its existence because late management can lead to increased maternal mortality. This paper reports the case of a 22-year-old lady at 18 weeks gestation who had generalized abdominal pain for two months. Prior to her arrival at our service, an abdominal and pelvic ultrasound done revealed a viable singleton 18-weeks intra-abdominal pregnancy with a moderate amount of abdominal fluid collection. The diagnosis of haemorrhagic shock complicating an abdominal pregnancy at 18 weeks of gestation was retained. An emergency laparotomy was done, and a right total salpingectomy and oophorectomy with resection of the right broad ligament were carried out. After surgery, dissection of the mass revealed a non-viable male foetus weighing 218 grams. In conclusion, there´s a very high morbidity and mortality rate associated with broad ligament pregnancies. Due to the fact that there is late access to antenatal care, the prognosis of pathologic pregnancies is endangered.

Embarazo ectópico abdominal con feto vivo en el Hospital Provincial de Bié, Angola / Abdominal ectopic pregnancy with a live fetus in Bié Provincial Hospital, Angola

El embrión, en condiciones normales, es concebido en la trompa y migra al útero. Un pequeño porcentaje que no llega a completar esta migración, se convierte en embarazo ectópico. Se presentó el caso de un embarazo ectópico abdominal con feto vivo; paciente femenina de 32 años de edad, multigesta con 4 partos eutócicos a término. A las 37 semanas de edad gestacional se remitió al Hospital Provincial de Bié por presentar dolor abdominal difuso, de moderada intensidad, que se exacerbaba con los movimientos fetales. Se realizó la cesárea, se encontró un embarazo ectópico abdominal con feto vivo y placenta implantada en fondo uterino, epiplón y colon transverso. Se dejó placenta in situ para un posterior seguimiento.

The embryo, under normal conditions, is conceived into the fallopian tube and migrates to the uterus. A small percentage of the embryos that do not complete this migration become an ectopic pregnancy. We present a 32-year-old female patient with multiple gestation pregnancies and 4 normal term deliveries who had an abdominal ectopic pregnancy with a live fetus. She was referred to Bié Provincial Hospital at 37 weeks' gestation due to diffuse abdominal pain of moderate intensity, which was exacerbated by fetal movements. A cesarean section was performed; an abdominal ectopic pregnancy with a live fetus and the placenta implanted in the uterine fundus, omentum, and transverse colon was found. The placenta was left in situ for further follow-up.

A case report of a successful multidisciplinary management of an abdominal pregnancy / Manejo multidisciplinario exitoso del embarazo abdominal. Reporte de un caso peruano

Abdominal pregnancy is defined as one that occurs outside of the uterus and fallopian tubes in the abdominal cavity. We present the case of a 30-year-old Peruvian female patient from Lima with a surgical history of exploratory laparotomy due to tubal ectopic pregnancy and appendectomy without further relevant personal or family histories. She attended the emergency room of a social security hospital in Peru with a referral from a district hospital and a diagnosis of abdominal pregnancy at 14 weeks of gestational age without previous prenatal controls. Symptomatology at hospital admission was colic-type abdominal pain in the hypogastrium without vaginal bleeding, fluid loss or fever. During hospitalization, she underwent an exploratory laparotomy with embolization of the uterine artery, left salpingectomy, and removal of the abdominal ectopic pregnancy. The evolution was favorable after the surgery, and she was discharged. Without further complications, she continues her controls at the obstetrics and gynecology outpatient service without complications.

El embarazo abdominal es aquel embarazo que ocurre fuera del útero y las trompas de Falopio en la cavidad abdominal. Presentamos el caso de una paciente peruana de 30 años proveniente de la ciudad de Lima, con antecedentes quirúrgicos de laparotomía exploradora por embarazo ectópico tubárico y apendicectomía, sin otras patologías ni antecedentes familiares de importancia. La paciente acude al servicio de urgencias de un hospital del seguro social en Perú derivada de un hospital distrital con diagnóstico de embarazo abdominal a las 14 semanas de edad gestacional, sin controles prenatales previos. La sintomatología al ingreso hospitalario fue dolor abdominal de tipo cólico a nivel del hipogastrio, sin sangrado vaginal, pérdida de líquidos o fiebre. Durante su hospitalización se le realizó una laparotomía exploratoria con embolización de la arteria uterina, salpingectomía izquierda y extracción del embarazo abdominal. La evolución fue favorable tras la intervención quirúrgica, siendo dada de alta. Actualmente continúa sus controles en el servicio de consulta externa del servicio de ginecología y obstetricia sin complicaciones.

A rare case of a live abdominal pregnancy in a woman with subsequent gestation in utero.

This report concerns now 40-year-old healthy woman who was born alive and healthy from an ectopic pregnancy in the abdominal cavity, with placental localization on the omentum. This was a historical case report 40 years ago, as at that time doctors had little information about similar case in the world. Even today, in the era of modern medicine, we find only rare cases where a child developed outside the uterine cavity is born healthy and without developmental deformities. The mother subsequently had a normal intrauterine pregnancy 2 years later, ending with a caesarean section and the birth of a healthy boy.

Effect of antenatal class attendance on fear of childbirth and antenatal stress

ABSTRACT OBJECTIVE To assess the effect of attending antenatal classes on fear of childbirth and antenatal stress in nulliparous pregnant women. METHODS A total of 133 nulliparous pregnant women participated in the study, which had a quasi-experimental design. Data were collected by a descriptive data form, the Wijma Delivery Expectancy/Experience Questionnaire, and the Antenatal Perceived Stress Inventory (APSI). RESULTS A significant correlation was found between antenatal class attendance and having a high schooling level and an intended pregnancy (p < 0.05). The mean fear of childbirth score of pregnant women was 85.50 ± 19.41 before the training and 76.32 ± 20.52 after the training, and the difference between these scores was significant (p < 0.01). Fear of childbirth score were not significantly different between the intervention group and the control group. The mean APSI score of pregnant women in the intervention group was 22.32 ± 6.12 before the training and 21.79 ± 5.97 after the training. However, this difference was not statistically significant (p = 0.70). CONCLUSION The fear of childbirth score decreased significantly in the intervention group after the training.

Embarazo ectópico abdominal de 23 semanas en primigestante. Reporte de caso / Abdominal ectopic pregnancy at 23 weeks prime pregnant. Case report

El embarazo ectópico abdominal es una patología poco frecuente, la cual consiste en un embarazo con implantación dentro de la cavidad abdominal y fuera del útero y sus anexos; siendo el menos frecuente de los embarazos ectópicos, y representando el 1 % de los casos. Sin embargo, cuando se presenta, la tasa de mortalidad materno-fetal es alta, por lo que representa una urgencia médica con complicaciones graves como hemorragia obstétrica. El diagnóstico requiere un alto grado de sospecha, debido a que el sangrado menstrual regular puede estar presente. Se presenta el caso de una paciente primigestante con embarazo ectópico abdominal en segundo trimestre, con manejo definitivo quirúrgico y posterior evolución materna favorable al postquirúrgico, sin embargo, con resultado perinatal adverso para el recién nacido. La importancia de este caso radica en su diagnóstico oportuno, por el cual se logró evitar complicaciones que pusieran en riesgo la vida de la paciente.

Abdominal ectopic pregnancy is a rare pathology, it is expressed by a pregnancy with implantation inside the abdominal cavity and outside the uterus and its annexes, being specifically the least frequent of ectopic pregnancies, representing 1% of cases. When it occurs, the maternal-fetal mortality rate is high1. The diagnosis requires a high degree of suspicion, due to regular menstrual bleeding may be present. It is a medical emergency with serious complications such as obstetric hemorrhage. We present the case of a prime pregnant patient with abdominal ectopic pregnancy in the second trimester with definitive surgical management, and subsequent maternal evolution favorable to post-surgery, however, with adverse perinatal outcome for the newborn. The importance of this case lies in its timely diagnosis, by which it was possible to avoid complications that put the patient's life at risk.

Normative references of fetal chest circumference in a Nigerian population

A linear relationship between gestational age and fetal thoracic size has been observed, with growth occurring at a regular rate from 16 to 40 weeks.Objective: To determine the fetal chest circumference in normal late second and third-trimester pregnancies in a Nigerian population.Materials and Methods: This was a descriptive cross-sectional study carried out on gravid women with normal singleton pregnancies at 22 ­ 38 weeks gestational age. We recruited 440 eligible gravid women. The fetal gestational age was estimated from the last menstrual period and an early first trimester ultrasound report (< 10 weeks). The fetal chest circumference was measured on an axial view of the fetal chest after ensuring adequate visualisation of the four cardiac chambers, both fetal lungs and ribs. The other fetal biometric parameters were determined using the previously established guidelines. Descriptive statistics, Pearson's correlation, and regression analysis were used as appropriate. Statistical tests were considered significant at P ≤ 0.05.Results: The mean age of the subjects was 29.8 ± 4.6 years (range = 18-45 years). The chest circumference of the fetuses ranged from 16.56 ± 0.29 cm to 30.87 ± 6.88 cm. The fetal chest circumferences increased with advancing gestational age (16.56 ± 0.29 cm at 22 weeks to 30.87 ± 6.88 cm at 37 weeks gestational age). There was strong positive correlation between chest circumference and menstrual gestational age (r=0.85, p=<0.0001), biparietal diameter (r=0.88, p<0.0001), abdominal circumference (r=0.90, p<0.0001) and fetal length (r=0.88, p<0.0001).Conclusion: The fetal chest circumference grew as the pregnancy progressed. There was a positive linear correlation between fetal chest circumference and menstrual gestational age as well as the other fetal biometric parameters.

Delayed diagnosis and management of late second trimester intra-abdominal pregnancy / Philippine Journal of Obstetrics and Gynecology

@#Abdominal pregnancy resulting in lithopedion is a rare condition constituting only 0.0054% of all pregnancies. This is a case of a 48-year-old Gravida 6 Para 3 (3-0-2-2) who consulted at the emergency room for an ultrasound finding of abdominal pregnancy. The patient had previous imaging done which showed a live intrauterine pregnancy until her fourth ultrasound, showing fetal death in utero. After several months without passage of the products of conception, a repeat ultrasound showed an abdominal pregnancy. Diagnosis of abdominal pregnancies may be difficult, thus it is important to utilize other imaging modalities to confirm the diagnosis. The mainstay for treatment for abdominal pregnancies is laparotomy. However, due to the possible severe hemorrhage that may arise intraoperatively, preoperative and postoperative arterial embolization of feeding vessels may be performed, as was done in the case discussed.

Manejo expectante de gestación ectópica abdominal tras fecundación in vitro en paciente con salpinguectomía bilateral: reporte de un caso / Expectant management of abdominal ectopic pregnancy following in vitro fertilization in a patient with previous bilateral salpinguectomy: a case report

ANTECEDENTES El embarazo ectópico abdominal es el menos habitual de los embarazos ectópicos, con una prevalencia situada entre el 0.9 - 1.4%. La mortalidad materna es elevada, alcanzando un 20% y la viabilidad fetal mínima. El manejo médico en estas situaciones es complicado ya que no está bien establecido debido a su baja frecuencia. CASO CLÍNICO Mujer de 35 años, con antecedente de esterilidad por endometriosis y salpinguectomía bilateral. Tras 5 fecundaciones in vitro (FIV) consigue una primera gestación, con finalización mediante cesárea por no progresión de parto. Acude a urgencias en su segundo embarazo, logrado tras 3 (FIV), con edad gestacional de 7 semanas. Presenta sangrado vaginal escaso y la ecografía demuestra a nivel de Douglas y hacia fosa iliaca izquierda un saco gestacional de 3 cm con embrión sin latido cardiaco de 5 mm. El nivel de β-hcg es de 1477 mUI/ml. Se diagnostica de gestación ectópica abdominal y se opta por actitud expectante dada la estabilidad clínica de la paciente. En un control a las 48h la β-Hcg es de 464 mUI/ml y la paciente se mantiene estable. En controles posteriores se observan niveles descendentes de β-Hcg y tras un mes la resolución es completa. CONCLUSIÓN El embarazo ectópico abdominal es una entidad poco frecuente pero con una alta tasa de mortalidad. Aunque lo más común es optar por un abordaje quirúrgico es necesario individualizar cada caso y basarse en la clínica y las diferentes pruebas diagnósticas para seleccionar aquellos casos que se pueden beneficiar de un manejo conservador.

BACKGROUND Abdominal ectopic pregnancy accounts for only 0.9-1.4% of all ectopic pregnancies. The maternal mortality rate is high (up to 20%) and fetal viability mínimum. The managment, specially the conservatory management of these cases is difficult because of our limited experiencie due to its low frecuency. CASE PRESENTATION 35-year-old woman, with history of sterility due to endometriosis that required bilateral laparoscopic salpinguectomy. Her first pregnancy (after 5 in vitro fertilization cicles (IVF)) finalized with a caesarean section because of to the lack of labour progresion. She was admitted to our emergency department during her second pregnancy (after 3 IVF cicles), with 7 weeks of gestational age. She had a little vaginal bleeding. Ultrasound scan showed a 5mm gestational sac with a 3mm embryo without cardiac activity in the pouch of Douglas. The β-Hcg level was 1477mUI/ml. The final diagnosis was ectopic abdominal pregnancy and it was decided to undertake an expectant management because she was clinically stable. The β-Hcg level after 48 hours was 464 mUI/ml. In subsequent examinations β-Hcg showed descending levels and after one month the resolution was completed. CONCLUSION Abdominal ectopic pregnancy is very infrequent but it has a high mortality rate. The most common approach is surgical but it is necessary to study all signs and diagnostic tests to select patients that could get profit from a conservatory management.