Diagnosis of abdominal pregnancy still a challenge in low resource settings: a case report on advanced abdominal pregnancy at a tertiary facility in Western Kenya

Abstract

Abdominal pregnancy is a rare form of ectopic pregnancy, occurring in 1: 10,000 to 1: 30,000 pregnancies and accounting for up to 1.4% of all ectopic pregnancies. It is classified as primary or secondary depending on the site of fertilization. However, when it does happen, it may remain unnoticed until term because the pregnancy can appear normal during clinical examination. Advanced abdominal pregnancy is associated with high mortality rate for both the mother and the baby at 1-20% and 40-95% respectively. We report a case of a 30-year-old female para 2+0, gravida 3 at 35 +1 who presented at a Tertiary facility in Eldoret Kenya with one-day history of per vaginal bleeding and 2 weeks' history of no fetal movements. The importance of this case report is to highlight the challenges associated with diagnosis of advanced abdominal pregnancy in low resource settings. Ultrasound alone cannot be relied on to make the diagnosis. Whenever an induction is not working, abdominal pregnancy should be considered.

Late abdominal pregnancy in a post-conflict context: case of a mistaken acute abdomen - a case report

“…Making the diagnosis of abdominal pregnancy is challenging. While in more developed settings, magnetic resonance imaging (MRI) is the diagnostic method of choice for abdominal pregnancy, particularly in the more advanced stages [2,14], in low-and middle-income countries, clinicians must rely on good clinical judgement, and where available, on ultrasound [1,10]. When performed in the first trimester, ultrasound will show an empty uterus with a separate gestational sac, or with a mass separated from the uterus, adnexa, and ovaries.…”

“…The diagnosis of abdominal pregnancy may be a surprise finding in the operating theatre, as was the case with our patient. For instance, some abdominal pregnancies are diagnosed at the time of emergency caesarean section for failed labor induction [2] and during elective caesarean section [7]. This is more common in low resource settings where access to imaging such MRI, and in some contexts ultrasound, is not possible.…”

“…Abdominal implantation of a pregnancy is uncommon, accounting for 1.4% of all ectopic pregnancies and with a reported range of 1:10000 to 1:30000 pregnancies [1][2][3]. Abdominal pregnancies have been reported in several contexts in both high-income countries as well as lowand middle-income countries.…”

“…Severe complications associated with ectopic pregnancies are well known including maternal and fetal death, especially with increased gestational age. With abdominal pregnancies, fetal mortality rates range from 40 to 95%, while maternal mortality ranges from 1 to 18% [2]. Because diagnosis is typically made late, the fetus is often already dead when the abdominal pregnancy is recognized [2,5].…”

“…With abdominal pregnancies, fetal mortality rates range from 40 to 95%, while maternal mortality ranges from 1 to 18% [2]. Because diagnosis is typically made late, the fetus is often already dead when the abdominal pregnancy is recognized [2,5]. With increasing gestational age, maternal complications can occur at any time in the antepartum, peripartum or postpartum periods.…”