Abdominal pregnancy, cesarean scar pregnancy, and heterotopic pregnancy
- Thomas A Molinaro, MD
Thomas A Molinaro, MD
- Clinical Assistant Professor, Division of Reproductive Endocrinology
- Robert Wood Johnson Medical School
- Kurt T Barnhart, MD, MSCE
Kurt T Barnhart, MD, MSCE
- Associate Professor of Obstetrics and Gynecology
- University of Pennsylvania
- Section Editors
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Co-Chief of Ultrasound
- Beth Israel Deaconess Medical Center
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics/Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Ectopic pregnancy is estimated to occur in 1 to 2 percent of pregnancies [1,2]. Over 90 percent are located in the fallopian tube, while the remainder implant in locations such as the abdomen, cesarean (hysterotomy) scar, cervix, and ovary . Given the rarity of implantation at these sites, much of the information surrounding diagnosis and treatment of these pregnancies has been derived from small observational studies and case reports. This makes the optimal approach to their evaluation and management difficult to determine.
Abdominal pregnancy, cesarean scar pregnancy, and heterotopic pregnancy will be reviewed here. The goal is to prompt clinicians to think of these diagnoses and to make suggestions for management, especially for avoiding catastrophe.
The diagnosis and management of ectopic pregnancies at other locations are discussed separately. (See "Ectopic pregnancy: Clinical manifestations and diagnosis" and "Ectopic pregnancy: Incidence, risk factors, and pathology" and "Ectopic pregnancy: Choosing a treatment and methotrexate therapy" and "Ectopic pregnancy: Surgical treatment" and "Cervical pregnancy" and "Ectopic pregnancy: Expectant management".)
Abdominal pregnancy refers to a pregnancy that has implanted in the peritoneal cavity, external to the uterine cavity and fallopian tubes. The estimated incidence is 1 per 10,000 births  and 1.4 percent of ectopic pregnancies [4-6]. There are reports of abdominal pregnancy occurring after hysterectomy [7,8].
Potential sites include the omentum, pelvic sidewall, broad ligament, posterior cul-de-sac, abdominal organs (eg, spleen, bowel, liver), large pelvic vessels, diaphragm, and the uterine serosa [5,9-17].
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- ABDOMINAL PREGNANCY
- Clinical manifestations
- Diagnostic evaluation
- Differential diagnosis
- CESAREAN SCAR PREGNANCY
- Clinical manifestations
- Diagnostic evaluation
- Differential diagnosis
- HETEROTOPIC PREGNANCY
- Clinical manifestations
- Diagnostic evaluation
- Differential diagnosis
- SUMMARY AND RECOMMENDATIONS