Advanced extrauterine pregnancy: diagnostic and therapeutic challenges.

OBJECTIVE

The objective of the study was to identify women with advanced extrauterine pregnancy, specifically assessing the problems encountered with their diagnosis and management, preoperative evaluation, and surgical removal.

STUDY

DESIGN

This was a case series including women diagnosed with an extrauterine pregnancy of 18 weeks' gestation or greater at our institution from 1980 to 2005.

RESULTS

We identified 10 women with advanced extrauterine pregnancies during the study period. Diagnosis was not optimal, and only 6 were discovered preoperatively. Despite the fact that only 3 of 10 women met diagnostic criteria for an abdominal pregnancy, surgical dissection was universally difficult, and hemorrhage was common with 9 of 10 patients requiring blood transfusions. In 2 women, the placenta was left in situ, and both developed serious complications. All 5 viable fetuses survived, but their courses were long and complicated.

CONCLUSION

Irrespective of placental implantation site, an advanced extrauterine pregnancy is a serious condition. The currently accepted definition of abdominal pregnancy is too exclusive.