The challenge in the diagnosis and management of an advanced abdominal pregnancy in a resource-low setting: a case report

Abstract

BackgroundAbdominal pregnancy is a rare form of ectopic pregnancy that is frequently left undiagnosed by inexperienced obstetricians and radiologists. It is associated with higher risk of maternal hemorrhage at any gestation and more at advanced gestation.Case presentationWe present the case of a 22-year-old sub-Saharan African woman, gravida 3 para 0, who was diagnosed with advanced abdominal pregnancy of 25 weeks’ gestation by a transvaginal ultrasound after the failure of two medical terminations of pregnancy in the first and second trimesters and a series of repeated obstetric ultrasounds showing intrauterine pregnancy. Laparotomy was done and her recovery was uneventful.ConclusionsThe management of advanced abdominal pregnancy is more challenging as compared to earlier gestation so patients with failed medical termination of pregnancy should be critically analyzed for ectopic pregnancy as early as possible.

Rare Ectopic Pregnancies – A Literature Review for the Period 2007 – 2019 on Locations Outside the Uterus and Fallopian Tubes

“…Abdominal CT or MRI imaging may provide additional useful information. While this is available in highly developed industrialized countries, CT imaging and MRI can be a problem in countries with more limited healthcare resources [13]. MRI is the best method of obtaining a diagnosis and planning the treatment of an EP located in the intra-or extraperitoneal space [3,6,65,110].…”

“…In the three cases who were delivered of a live infant, in addition to implanting on the bowel and its mesenteries, the placenta was also connected to the uterine serosa 11 , 12 , 13 .…”

“…In den 3 Fällen mit Lebendgeburt hatte die Plazenta zusätzlich zur Implantation an Darm und seinen Mesenterien auch Anschluss an serosale Flächen des Uterus 11 , 12 , 13 .…”

“…Ergänzend können ein CT- oder MRT-Abdomen hilfreich sein. Dies stellt, anders als in hoch entwickelten Industrieländern, in ressourcenärmeren Gesundheitswesen sicher eine besondere Schwierigkeit dar 13 . Eine MRT ist für die Diagnosestellung und Therapieplanung von EUG im Intra- und Extraperitonealraum am besten geeignet 3 , 6 , 65 , 110 .…”

Hemoperitoneum during removal of the placenta in advanced abdominal pregnancy with live fetus delivered at 37 weeks of gestation. A case report in a low-resource setting and literature review

“…Maternal deaths were due mainly to massive bleeding, septic shock, pulmonary embolism. After 2012 we have identified other 14 cases of advanced abdominal pregnancies with newborns survival [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , 25 ].…”