Abdominal Pregnancy

By Meg Marinis, Director of Medical Research May 12, 2011
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YIKES! BABY IN THE INTESTINES!

First, it was the excited screams in the writers' room when writer-producer Zoanne Clack (and awesome physician who happened to write this episode!) pitched the idea of a baby's face in the abdomen. Then, it was the shocked (and a little disgusted) gasps from the actors at the cast read-thru of the script. And now it's on the television screen.

Yeah, I've seen it and read it a hundred times. And I still have the same reaction to it: My shoulders bunch up, my face scrunches, my body shudders a bit, and I make a sound that I really can't figure out how to describe in words.

Abdominal pregnancy is a type of ectopic pregnancy, when the fetus abnormally develops outside the uterus.

Ectopic pregnancies occur when a condition interrupts the movement of a fertilized egg through the fallopian tube to the uterus. Either the egg encountered a physical blockage or other factors contributed to scarring in the tube such as a past ectopic pregnancy, infection, or surgery. The most common site for an ectopic pregnancy is within one of the fallopian tubes, but they can also start to develop in the ovary, cervix, or stomach area (an abdominal pregnancy such as Lebo's case).

According to the National Institute of Health, ectopic pregnancies occur in 1 in every 40-100 pregnancies.

Why? For many women, the cause is unknown. But approximately half of the women who have had an ectopic pregnancy have suffered from swelling/inflammation of the fallopian tubes (also known as salpingitis) or pelvic inflammatory disease (PID). Other related factors may include endometriosis, birth defects of the fallopian tubes, complications of a ruptured appendix, and scarring caused by previous pelvic surgery. Some researchers also suggest that an age over thirty-five, several sexual partners, and in vitro fertilization may contribute to ectopic pregnancies.

An abdominal pregnancy is a rare complication of an ordinary ectopic pregnancy.

Unfortunately, as we saw with Lebo, abdominal pregnancy can be a diagnostic challenge because it does not always present with clear signs. These women may suffer from persistent abdominal pain, gastrointestinal symptoms, and vaginal bleeding—all very non-specific clues to the problem. However, when physically examined by a health professional, the baby's parts might easily be detected, and the "lie" of the baby is abnormal (the position of the baby in relation to the mother).

Now the fetus may implant anywhere within the abdominal cavity, but due to the large size of the placenta, it normally attaches to the gut or omentum. Common places include the pouch of Douglas, on the ovary, or on the wall of the pelvis. Ultrasounds can be helpful in determining suspicion of an abdominal pregnancy, but they aren't always 100% accurate. It can show findings such as an empty uterus and lack of amniotic fluid. An MRI usually catches them every time.

Ectopic pregnancies, especially within the abdomen, rarely survive to term.

Lebo is extremely lucky that she happened to collapse while at Seattle Grace. If an ectopic pregnancy ruptures, it can lead to severe bleeding, endangering the life of the mother. This would usually occur fairly early on in the pregnancy since most of the time, the body cannot sustain a pregnancy outside of the uterus. This medical emergency can lead to hemorrhagic shock and even death. Treatment for shock includes rapid blood transfusion, fluids, oxygen, keeping the mother warm, and raising the legs. Following a rupture, typical treatment involves a laparotomy (abdominal surgery) to confirm the ectopic pregnancy, remove the abnormal pregnancy, and repair any tissue damage. Sometimes the surgeon must even remove the fallopian tube. According to the NIH, approximately one-third of women who have had an ectopic pregnancy will become pregnant again.

However, like Lebo, some abdominal pregnancies do advance past 24 weeks of gestation. Careful monitoring and maternal care need to be in place though because women with abdominal pregnancies will not go into labor normally. Delivery will be done through a laparotomy, and if the baby does survive, he or she may have birth defects due to compression without the protection of amniotic fluid.

Even though most ectopic pregnancies cannot be prevented, some safety precautions may reduce the risks, especially for tubal pregnancies.

- Stopping smoking.
- Decreasing the risks for PID which include having multiple sexual partners, unprotected sex, and sexually transmitted diseases (STDs).
- Early diagnosis and treatment of STDs.
- Early diagnosis and treatment of salpingitis and PID.

For more information on ectopic pregnancy, please visit:

http://www.nlm.nih.gov/medlineplus/ency/article/000895.htm