Abdominal pregnancy: two cases of critical obstetric conditions with different perinatal outcomes. Case report

Abdominal pregnancy (AP) is rare and is associated with high rates of maternal and perinatal mortality compared to other ectopic pregnancies (EP). Despite using advanced imaging techniques in prenatal diagnosis, diagnosing and treating AP remain challenging. Progressive advanced AP may remain undiagnosed for a long time due to the absence of specific clinical symptoms, errors in the interpretation of echographic patterns by radiologists, and a lack of alertness due to the rarity of this type of EP. This article describes two authors' observations of AP that resulted in critical obstetric conditions due to massive blood loss. The first case of AP in a pluripara patient concluded at week 34 with live birth and hysterectomy for placenta ingrowth (PAS2). In the second case, the AP was terminated early. In both patients, the trophoblast was implanted on the uterus; there were no known risk factors for EP, and the diagnosis of AP was established intraoperatively. According to modern Russian and foreign literature, in most cases, EP is diagnosed intraoperatively due to the lack of a standard algorithm for diagnosis and treatment. Standardization of treatment guidelines for AP trimesters II and III, perioperative treatment options, and postoperative management, based on a summary of all cases reported worldwide, could reduce the risk of maternal and fetal complications and mortality.