23 - abdominal pregnancy

Which of the following statements concerning abdominal pregnancy
is correct?
a. Gastrointestinal symptoms are quite often severe
b. Fetal survival is approximately 50%
c. Aggressive attempts should be made to remove the placenta at the time of initial
surgery
d. It may result in infectious morbidity prior to the diagnosis
e. It is usually the result of a primary abdominal implantation

The answer is d. (Schwartz, 7/e, pp 1838–1843. Ransom, 2000, pp
36–37.)

Abdominal pregnancy usually follows a tubal pregnancy with either
tubal rupture or spontaneous passage through the fimbriated end. Although
women with abdominal pregnancy usually report an increase in gastrointestinal
symptoms, these are rarely severe enough to lead to investigation.
Fetal death rates are reported to be above 90% with abdominal pregnancies.
Infection of the gestational products can occur especially when the placenta
adheres to the intestines. This can lead to abscess formation and the possibility
of rupture. Although leaving the placenta in the abdomen following
surgical delivery predisposes to postoperative coagulation problems as well
as the need for subsequent surgery, these complications can be less severe
than the hemorrhage associated with attempts at removal at the time of primary
delivery. If the placenta cannot easily be removed, recommendations
are to leave it in place at the time of the first surgery.