After a week of abdominal pain that couldn’t be relieved, trouble urinating, and fewer than usual movements of the baby she was carrying, a 22-year-old woman from rural Tanzania was referred to a medical center in a nearby city. It was there that a stunning discovery was made — her baby was growing freely in her abdominal cavity, not in her uterus at all. Immediate surgery resulted in the birth of a healthy baby girl at 32 weeks gestation and possibly saved the mother’s life.
Abdominal pregnancy is a rare and dangerous medical condition that is easy to miss during routine ultrasound exams. The Tanzanian mother had had only two ultrasound scans during her pregnancy and they revealed nothing unusual.
According to Dr. Jill Rabin, “Many times, these pregnancies are not diagnosed until the labor,” when the woman experiences contractions, the cervix is dilated for delivery, and nothing happens. During her 25 year medical career, the Chief of Ambulatory Care, Obstetrics and Gynecology, says she’s seen only four or five abdominal pregnancies. Rabin works at the Long Island Jewish Medical Center in New Hyde Park, New York, and was not involved with the Tanzanian case.
Abdominal pregnancy, a form of ectopic pregnancy, is estimated to occur only about once in every 10,000 pregnancies. It begins when an embryo implants in a fallopian tube (ectopic) and then moves backward up the tube toward the ovary, away from the uterus. Once at the open end of the fallopian tube, the embryo implants a second time in the abdominal cavity.
Symptoms of abdominal pregnancy include fetal movements that cause pain to the mother and gastrointestinal problems. Because the baby is visible on ultrasound scans, its location outside the uterus is often overlooked. Without the cushioning protection of the uterus, it’s easier than usual to feel the parts of the baby’s body.
Rabin says most babies she’s seen born from abdominal pregnancy are small but healthy because, throughout the pregnancy, the placenta is attached to vascular tissue that allows access to the mother’s nourishing bloodstream.
When abdominal pregnancy is identified in the first trimester, termination is usually advised; as with ectopic pregnancies, abdominal pregnancy can be life-threatening for the mother. If detected later, the mother must be carefully monitored during pregnancy and after delivery. Severe bleeding can occur if the placenta is surgically removed when the baby is taken. As a rule, the placenta is left intact so the mother’s body can reabsorb it, a process that can take months and requires medical monitoring.
In the case of the woman in Tanzania, the placenta was successfully removed surgically so mother and baby were released from the hospital at the same time with no expectation of complication.
Source: Matovelo, Dismas, and Nhandi Ng’walida. “Hemoperitoneum in advanced abdominal pregnancy with a live baby: a case report." BMC ResearchNotes. BioMed Central Ltd. Feb 25, 2014. Web. Mar 19, 2014.