Background:   Abdominal pregnancy accounts for up to 1.4% of ectopic pregnancies.  These pregnancies can go undetected until an advanced gestational age and often result in severe hemorrhage. 

Case:   This case presents a 29 year old G1 P0 white female who was admitted to the hospital due to a confirmed intraabdominal pregnancy.  The patient was approximately 20 6/7 weeks based on ultrasound data.  The patient was seen by her family physician as an outpatient and then referred to a perinatologist.  The patient was found to have implantation in the right lateral anterior uterus as well as the right broad ligament.  The patient was admitted for additional imaging with potential surgery in 1-2 days. The patient had a CT angiogram performed to assess the blood supply to the placenta for preoperative evaluation.  The angiogram showed the placenta also appeared to be implanted within the right uterine wall and right broad ligament.  An ethics consult was requested by the perinatologist to explore all aspects of this case.  The fetus demonstrated adequate interval growth. Through ethics case consultation, review of the ethical religious directives, other perinatologist expert opinions as well as discussion with family and staff members, the decision was made to undergo uterine embolization. A nurse from the Labor and Delivery perinatal loss team met with the patient and family prior to the MRI and would remain with the family throughout the remaining tests, surgery, and recovery period.  Just prior to the MRI, the patient developed hypotension, tachycardia and sever intraabdominal and pelvic pain.  Although in the radiology department, the L&D nurse initiated the call to the OB rapid response team and directed the members to the OR suite.  Upon arrival in OR, the patient had a severe bradycardic episode and hypotension with progression to a lack of pulse, consistent with hemorrhagic shock.  The patient did not require CPR as she responded to vasopressors.  The fetus was delivered within five minutes of arrival in the OR and was stillborn. After receiving 6 units of RBC’s 6 of FFP and 6 unites of platelets, she was moved to the Intensive Care Unit. Estimated blood loss was 3500 cc.  

Conclusion:   Over the next five days, her condition was closely monitored. Nursing care was provided by ICU and L&D staff in an effort to meet all aspects of the critically ill OB patient and her family. 

Keywords:  OB rapid response team; ethics and abdominal pregnancy.