Australian and New Zealand Journal of Obstetrics and Gynaecology 2005; 45: 518–521 518 © 2005 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Blackwell Publishing, Ltd. Short Communication Advanced abdominal pregnancy Advanced abdominal pregnancy: still an occurrence in modern medicine Rae V. ROBERTS, 1 Jan E. DICKINSON, 1,2 Yee LEUNG 1 and Adrian K. CHARLES 1,2 1 King Edward Memorial Hospital for Women, and 2 School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia Abstract In a world bewildered by spectacular advances in imaging technology, the early detection of an abdominal pregnancy should be a feasible objective. A case of an advanced abdominal pregnancy is presented. Although the pregnancy was the result of in vitro fertilisation technology, the diagnosis was not suspected until 35 weeks gestation. Both ultrasound and magnetic resonance imaging (MRI) were used to achieve a diagnosis prior to delivery. The placenta was left within the peritoneal cavity but removal was necessitated for maternal symptomatology 4 months postdelivery. This case illustrates that despite the almost ubiquitous usage of prenatal ultrasound, extrauterine pregnancies may not be detected in a timely manner unless attention to basic ultrasound techniques is followed. Introduction Abdominal pregnancy is a rare form of ectopic pregnancy in which the conceptus is sited within the peritoneal cavity external to the uterus, fallopian tubes and broad ligaments. Unsupported by the endometrium, the placenta may attach to peritoneum, bowel, uterine serosa and omentum. Compared with other forms of ectopic gestations, maternal and fetal morbidity and mortality rates are increased in abdominal pregnancies. 1,2 The principal determinant of the maternal outcome in advanced abdominal pregnancy is the placental management strategy employed. 3 Recent management trends have been to leave the placenta in situ to await natural resolution, endeavouring to reduce maternal morbidity from haemorrhage and organ damage. 3–6 The early diagnosis of abdominal pregnancy is feasible with contemporary ultrasound; however, several case reports in the recent obstetric literature of third trimester diagnosis of this condition highlight the requirement for a systematic approach to early-pregnancy localisation. 3–6 We report a case of the third trimester diagnosis of an abdominal pregnancy following in vitro fertilisation. This case is notable for two features: the failure of early diagnosis despite prenatal ultra- sound and the failure of a conservative placental-management approach, with requirement for secondary surgical removal of the placenta 4 months post-partum. Case report A 39-year-old woman with a 15-year history of primary infertility as a result of tubal occlusive disease conceived following her ninth in vitro fertilisation procedure. Early pregnancy ultra- sound assessments at the treating fertility clinic reportedly demonstrated a single live embryo within the uterine cavity. A fetal anatomy survey at 19 weeks gestation was reported to show a complete placenta praevia. The pregnancy progressed in a clinically uncomplicated manner until an ultrasound assessment for placental localisation at 35 weeks gestation. At this ultrasound the uterus was noted to be small and deviated toward the left pelvic sidewall. The placenta was located immediately superior to the uterus and filled most of the lower abdomen (Fig. 1). The fetus was contained within a gestation sac separate from the uterus and cervix, with bowel seen actively peristalsing adjacent to the thin-walled sac. The fetus was appropriately grown with normal amniotic fluid volume and normal umbilical arterial Doppler studies. A diagnosis of an advanced abdominal pregnancy was made. A magnetic resonance imaging (MRI) examination that confirmed the ultrasound findings was performed, but did not provide any additional information. A midline laparotomy under general anaesthesia was con- ducted soon after the diagnosis, and a live male fetus of birth weight 3255 gm delivered in an uncomplicated manner. The infant was vigorous at birth and there were no adverse perinatal sequelae. The fetus was contained within an intra-abdominal Correspondence: Dr Jan E. Dickinson, School of Women’s and Infants’ Health, The University of Western Australia, King Edward Memorial Hospital for Women, 374 Bagot Road, Subiaco, Western Australia 6008, Australia. Email: jand@cyllene.uwa.edu.au Received 25 July 2005; accepted 5 August 2005.