1. Mengapa kehamilan abdomen paling banyak di broad ligament?

Early abdominal pregnancies (identified at <20 weeks' gestational age) the most-common
location was the pelvic peritoneum (24%) with the posterior cul-de-sac (20%) more common
than the anterior cul-de-sac (4%). Other commonly reported locations are the uterine serosa,
omentum, and bowel; more rarely reported sites include the liver,spleen, and retroperitoneum. 1
Broad ligament pregnancy is very rare and has a reported incidence of 1 in 1,83,900
pregnancies and occurs in about 1 in 245 ectopic pregnancies. Primary broad ligament ectopic
pregnancy occurs within the broad ligament itself whereas Secondary Broad ligament Pregnancy
occurs following tubal rupture and grows in the broad ligament.2
Literature review shows that 29.4% of women with broad ligament pregnancy had
previous history of any tubal surgery, majority having ipsilateral salpingectomy and
approximately 12% had conceived from in vitro fertilization. 3 Broad ligament pregnancy might
be more prevalent in patient with these risk factors.

2. Kapan rekomendasi dilakukan MRI pada kehamilan abdomen?

Ultrasonography is the initial diagnostic test of choice for abdominal pregnancy, is

unable to image the fetus in relation to the whole placenta and the uterine wall. 4
MRI role in abdominal pregnancy: 4
1. Multiplanar imaging, multiparameter imaging, excellent resolution in soft tissue, the
absence of radiation
2. Confirm the diagnosis
3. Delineate the exact anatomical relationships of the fetus, the placenta, and maternal
intraabdominal organs, and detail vascular and placental organ invasion for preoperative
planning.
4. Identification of the site and extent of placenta on MRI can affect the decision whether to
remove or leave the placenta in situ, and direct the operating obstetrician to open the
abdomen via correct incision, thereby avoiding a catastrophic hemorrhage once the
placental bed is incised.
5. In cases of advanced gestational age  diagnosis of fetal severe congenital abnormalities

The indications for an MRI in such case of suspected abdominal pregnancy by sonography:4
1. Nonvisualization of normal uterine wall around the fetus
2. An empty uterus
3. Evaluating the site and extent of placenta
4. Figuring the exact anatomical relationships of the fetus, the placenta, and maternal intra-
abdominal organs.

What to evaluate on MRI for cases of suspected abdominal pregnancy:4

1. Fetus: determination of intra-abdominal extrauterine fetal presence; lie, position, and
relation to the uterus and maternal intra-abdominal organs; viability; congenital
abnormalities; signs of fetal demise/ maceration/ hydrops.
2. Placenta: site and extent of implantation; most possible placental blood supply; bleeding
of placental bed; placental infarction.
 3. Amniotic sac: oligohydramnios; signs of rupture of membrane and leakage of amniotic
fluid.
4. Uterus: integrity of cervix, uterine wall, and endometrial cavity; signs of uterine rupture
and possible exit of the embryo/fetus.
5. Nature of the intra-abdominal fluid and amniotic fluid: hemorrhagic or clear.
6. Any maternal pathology detected by chance, such as uterine and ovarian neoplasms.

References:
1. Poole A, Haas D, Magann EF. Early abdominal ectopic pregnancies: a systematic review
of the literature. Gynecol Obstet Invest. 2012;74(4):249-60. doi: 10.1159/000342997.
Epub 2012 Oct 25. PMID: 23108297.
2. Rudra S, Gupta S, Taneja BK, Garg M. Full-term broad ligament pregnancy. BMJ Case
Rep. 2013 Aug 7;2013:bcr2013010329. doi: 10.1136/bcr-2013-010329. PMID:
23925683; PMCID: PMC3761789.
3. Cheung CSY, Cheung VYT. Broad ligament ectopic pregnancy. CRSLS e2014.00102.
doi:10.4293/CRSLS.2014.00102.
4. Deng MX, Zou Y. Evaluating a magnetic resonance imaging of the third-trimester
abdominal pregnancy: What the radiologist needs to know. Medicine (Baltimore). 2017
Dec;96(48):e8986. doi: 10.1097/MD.0000000000008986. PMID: 29310411; PMCID:
PMC5728812.