The Normal site for placental implantation is within the uterine cavity, but gestation at

extra-uterine sites does occur, a so-called ectopic pregnancy.  Locations include interstitial
(cornual), cervical, and intra-abdominal sites, but most occur in the isthmic or ampullary
portions of the fallopian tube(1). Patients present with severe cramp-like pains in the lower
abdomen, a hard irregular abdominal mass, nausea and vomiting and the classic triad of
amennorhoea, adnexal pain and vaginal bleeding.   

Abdominal pregnancy - where the pregnancy occurs at any other site within the abdomen,
and usually to rectal or uterine serosa -  accounts for 0.6 to 4% of all ectopic pregnancies.
Most of these are believed to be secondary,  i.e. resulting from reimplantation of an
ampullary pregnancy.

The first mention of abdominal preganacies occurred in the 11th century, made by an arabic
surgeon. However diagnosis is notoriously difficult, even with ultrasound, and therefore
patients often present only when complications occur.

Consequently it is widely held that  the haematological and spatial requirements needed for
normal growth and development of a fetus, including the decidual reaction, are not present
outside of the uterus. However, full-term cases have been reported - albeit infrequently - as
1 in 3372 - 21,439 in live births. It is believed that the difficulty and hence delay in diagnosis
might be the cause of high mortalities, and as a consequence most advocate imemdiate
laparotomy once diagnosis is established. The risks of ectopic pregnancy include the risk of
maternal mortality ranging from 0 - 50% and risk of infertility depending on patency of
fallopian tubes afterwards.

However, cases of full-term abdominal pregnancy have occured in which the sac ruptures
and  the fetus is discharged into body of cavity - with developemnt possible as long as the
placenta remains intact, and communication with the mother maintained. The management
of placenta remains an unsolved problem. - there is a balance between higher risk of
haemorrhage if removed, versus sepsis, abscess formation, secondary haemorrhage,
intestinal obstruction and amniotic cyst formation if left.

As the phenomenon of a full-term extra-uterine abdominal pregnancy has been shown to

exist, we aim to address the theoretical question of whether adequate placental and
hormonal management in the male, might be a plausible reality.

Mimics lots of otehr pathiology; incl PID,

Normal Hx: patient misses 1 or 2 periods and then develops sudden, severe cramp-like pains
in lower abdomen, N+V
1.. Molinaro TA, Barnhart KT. Ectopic pregnancies in unusual locations. Semin Reprod Med.
Mar 2007;25(2):123-30.