Advanced abdominal pregnancy

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 5 – A N T E N ATA L C A R E

Advanced Abdominal Pregnancy: Challenges, Update and Review of Current Management McDougall A et al. Advanced abdominal pregnancy: challenges, update and review of current management. TOG 2022;24:195–204. doi:10.1111/tog.12808

1:10,000–30,000 0–12% >78% INCIDENCE (LIVE BIRTHS); ~1% OF ECTOPICS MATERNAL MORTALITY (RECENT ESTIMATES) FETAL SURVIVAL (RECENT ESTIMATES)

DO N' T-M IS S FA C TS

  1. No specific diagnostic criteria for AAP – only ~50% diagnosed preoperatively; maintain a high index of suspicion for persistent abdominal pain, displaced cervix, failed induction, oligohydramnios

  2. MRI is gold standard for placental implantation/preoperative planning; 1.5T/3.0T, T1/T2 + SPIR fat-suppression + MRA (time-of-flight); no contrast required

  3. UK feticide required >21+6 weeks before termination of pre-viable AAP

  4. Delivery only surgical: midline/paramedian laparotomy, GA, tertiary centre, 24-hour interventional radiology, cell salvage available; deliver fetus without disturbing placenta

  5. Placenta: remove at surgery if MRI shows safe to do so; if major vessel invasion – ligate/embolise first; if unsafe – clamp cord close to placenta, leave in situ, monitor resorption

  6. Methotrexate for retained placenta carries high abscess/sepsis risk – not routinely recommended

  7. Maternal mortality up to 12%; blood transfusion needed in 70–90% of cases – ensure 24h blood product access

  8. Hysterectomy required in 12.6% and salpingo-oophorectomy/adnexectomy in 12.7% of published cases – consent must cover these possibilities

IMPLANTATION SITE & PROGNOSIS

Better prognosis: uterus/adnexa (stable blood supply) Higher haemorrhage risk: bowel, omentum, major vessels, liver/spleen

ABBREVIATION KEY

AAP — advanced abdominal pregnancy (>20 weeks) bhCG — beta-human chorionic gonadotrophin

EAP — early abdominal pregnancy (<20 weeks) IUCD — intrauterine contraceptive device

MDT — multidisciplinary team IVF — in vitro fertilisation

MRI — magnetic resonance imaging SPIR — spectral presaturation with inversion recovery (fat- suppressed MRI sequence) MRA — magnetic resonance angiography DIC — disseminated intravascular coagulation

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — 2022;24:195–204. doi:10.1111/tog.12808

Clinically reviewed by NHS obstetricians and gynaecologists

MRCOG AI is an independent educational tool. It is not affiliated with, endorsed by, or connected to the Royal College of Obstetricians and Gynaecologists (RCOG).

Included with a Pass Package

Start free