Induction of Labour in Advanced Abdominal Pregnancy with Fetal Demise due to Cord Round Neck: A Case Report of a Missed Diagnosis

Abstract

Background There are increasing reports of term live abdominal pregnancies even though the diagnosis of abdominal pregnancy is made preoperatively only in 45% of cases which partly explains the high maternal and perinatal morbidity and mortality associated with abdominal pregnancy. Case Report We report a rare case of misdiagnosed term abdominal pregnancy complicated by fetal demise due to cord round neck in a 29-year-old G3P2002 at 39-week and 1-day gestation. She noticed reduced fetal movements for which upon examination fetal death was diagnosed. Cervical ripening was started which eventually failed, and surgery was indicated. Findings were an abdominal pregnancy with a third-degree macerated fetus with cord round neck. She was discharged on day 8 postoperation to continue follow-up as an outpatient with regular βHCG and ultrasound checks. Conclusion This case illustrates the need to effectively confirm an intrauterine location of a pregnancy even in a case of fetal demise and the need to monitor for cord abnormalities in advanced abdominal pregnancy being managed expectantly.

Advanced abdominal pregnancy: challenges, update and review of current management

“…The diagnosis of AAP is commonly made following fetal demise. 19,29,[34][35][36][37][38] Numerous cases describe the diagnosis of AAP intraoperatively only after failure to induce labour. 10,34,37,39 An oxytocin stress test (absence of uterine contraction with oxytocin administration) has previously been used to aid diagnosis.…”

“…The diagnosis of AAP is commonly made following fetal demise 19,29,34–38 . Numerous cases describe the diagnosis of AAP intraoperatively only after failure to induce labour 10,34,37,39 .…”

“…19,29,[34][35][36][37][38] Numerous cases describe the diagnosis of AAP intraoperatively only after failure to induce labour. 10,34,37,39 An oxytocin stress test (absence of uterine contraction with oxytocin administration) has previously been used to aid diagnosis. 40 The nonspecific nature of the pain has led to various misdiagnoses, including fibroid degeneration, 41 bowel obstruction, uterine rupture 38 and septic peritonitis.…”