Abstract
BACKGROUND: Abdominal ectopic pregnancy is a rare complication with high maternal and perinatal morbimortality. The objective was to present the multidisciplinary management of an advanced abdominal ectopic pregnancy associated with COVID-19, and a review of the literature. CLINICAL CASE: 33-year-old multiparous patient with an abdominal ectopic pregnancy of 34 weeks, diagnosed by ultrasound at 27 weeks. 6 days prior to admission she started with diffuse abdominal pain. She was referred with positive RT-PCR test for SARS-CoV-2, without respiratory symptoms. CT scan reported probable infiltration of bowel loops, bladder roof and right ureter. Abdominal ultrasound corroborated the diagnosis and showed absence of involvement of iliac and ureteral vessels. MRI reported vascular contribution of the placental bed dependent on the right iliac artery and distal branches of the superior mesenteric artery. Exploratory laparotomy was performed, finding a live fetus in the abdominal cavity with a ruptured amnion, weight 2385 g, Apgar 5/8; placenta with implantation in the broad ligament, salpinges, ovary, bladder roof, infundibulopelvic ligament and appendix. A total abdominal hysterectomy was performed with right salpingo-oophorectomy, left salpingectomy and appendectomy. The total bleeding was of 3000 mL and there was a favorable post-surgical evolution. CONCLUSION: Abdominal ectopic pregnancy represents a challenge in obstetrics. Offering a multidisciplinary management allows to have a favorable outcome.