Diagnosis of ectopic pregnancy in the abdominal cavity

Ectopic pregnancy occurring in the abdominal cavity is a relatively rare clinical situation, but the consequences are serious. Due to abnormal placental attachment and insufficient blood supply, the fetus is unlikely to survive to full term. The following examination methods should be used for diagnosis:

Uterotonic injection test

In the case of intrauterine pregnancy, after the injection of a small dose of uterotonics, the contraction of the uterine smooth muscle will show a clear uterine shape; while in the case of abdominal pregnancy, there is no change because there is no uterine smooth muscle outside.

Lipiodol contrast

In cases of fetal death, hysteroscopy can be performed, which shows that the uterus is biased to one side, obviously bent, and inverted triangle-shaped. The uterus is normal in size or slightly enlarged, and the fetal image can be seen outside the uterus. Isotope tomography shows two clearly separated isotope active areas in abdominal pregnancy, one for the placenta and the other for the uterus.

B-ultrasound examination

The uterus is enlarged, and there are diffuse scattered light reflections in the uterine cavity, but there is no halo of the gestational sac. The fetus and placenta reflections can be seen in the abdominal cavity. However, sometimes, except for the uterus and fetal head, other structures are difficult to identify.

Abnormal fetal posture

The fetus is facing downward, with the limbs not bent in front of the trunk but hanging down, the back facing upward, and the presenting part not entering the pelvis even in late pregnancy;

The lateral view shows that the fetal and maternal spines overlap;

Ectopic and/or fetal shadow overlap of maternal intestinal gas;

Calcification of the fetus and amnion is a sign of lithotripsy;

If the fetus dies and is infected with gas-producing microorganisms, gas may appear in the amniotic cavity. When it accumulates to a certain extent, the inner edge of the amniotic cavity can be displayed.

If there is gas in the intestine, the outer edge of the thickened amniotic membrane can be highlighted, and the developed amniotic sac can be seen above the pelvic cavity.