Undiagnosed advanced abdominal pregnancy: a case report

<p class="abstract">Abdominal pregnancy is a rare form of extra-uterine gestation in which implantation occurs in the peritoneal cavity, unlike this case it rarely reaches advanced gestation and viability of fetal outcome are not commonly documented. Abdominal pregnancy accounts for about 1-2% of ectopic gestation. It is associated with poor fetal outcome and great morbidity and mortality due to heamorrhage especially in a low resource setting. We present an undiagnosed advanced case of abdominal pregnancy of a 30 yr old unbooked G2P1+0 (1A) with early ultrasound estimation of 37 weeks and 6 days. She presented with (abdominal) labour pains and ultrasound diagnosis of breech presentation, suspicion of a bicornuate uterus and intrauterine growth restriction. She was planned for emergency cesarean delivery on this basis but found advanced abdominal pregnancy, and subsequently on delivery had good maternal and fetal outcome. Abdominal pregnancy with live fetus is extremely rare, and requires a high index of suspicion, to avoid high risk of maternal morbidity and mortality and it is also imperative for all healthcare givers to localized pregnancy whenever they get in contact with a woman who has recently missed her period.</p>

Advanced Abdominal Pregnancy (AAP) after 20 Weeks of Gestation in Japan: A Retrospective Review

Background. An advanced abdominal pregnancy (AAP) rarely continues to a live birth, but sometimes, a live birth may occur. In developed countries, women with AAP who have not been diagnosed preoperatively are expected to be diagnosed quickly, and the pregnant woman and the fetus will be saved. After careful examination of the past cases, we sought to derive what is the best diagnosis and treatment choice in the current medical environment. Materials and Methods. We retrospectively studied AAP cases in Japan. We examined diagnosis of AAP before fetal delivery and placental treatment at the time of delivery. AAP was well documented in 10 cases. We contacted the AAP authors, who reported 10 AAP cases in Japan, directly to confirm any unclear points. Results. Two cases were diagnosed with AAP before laparotomy, one was diagnosed after IUFD, and seven were diagnosed at the time of laparotomy. The two most recent cases were diagnosed with AAP preoperatively by ultrasound and MRI. Six cases were described for preoperative diagnosis. There were two cases of placenta previa, one of a bicornuate uterus, one of breech presentation, one of a combination of uterine cervical fibroids and placenta previa, and one of a combination of presentation and placental abnormality with uterine fibroids. In five cases, the placenta was removed at the time of laparotomy. Simultaneous removal of the placenta during laparotomy could not be performed because of intra-amniotic infection with a macerated fetus in an IUFD case. Among eight cases, excluding 20-week and 21-week gestation with no expectation of viable newborns, there were one male and seven female fetuses. The birth weight ranged from 1765 to 3520 g, with a median birth weight of 2241 g. Combined malformations were described in six of the seven live births. Clubfoot, torticollis, joint contracture, and bone deformity were transient because intrauterine compression quickly improved. Conclusion. In recent cases, AAP has been diagnosed by MRI and ultrasound. MRI should be performed if abdominal pregnancy is suspected. Postoperative infections may occur if the placenta is not removed at the time of delivery. We recommend placental resection with the help of an anesthesiologist, a gynecologist, a urologist, and a surgeon in the current medical environment.