Post Term Extrauterine Abdominal Pregnancy, a case report

Abstract

Introduction

When implantation of the fertilized ovum occurs anywhere outside of the uterine cavity it is called ectopic pregnancy. Abdominal pregnancy is a rare type of ectopic pregnancy where the developing embryo implants and grows within the peritoneal cavity. Abdominal pregnancy is classified as being primary and secondary. Most abdominal (ectopic) pregnancies are secondary from aborted or ruptured tubal pregnancy. Extrauterine abdominal pregnancy is missed during antenatal period even with the use of ultrasound.

Case history

A 39 years old woman gravida VI, para V with history of severe supra pubic pain at 10 weeks of amenorrhea which was treated with Antipain and bed rest presented to the maternity hospital. During ante natal follow up abnormal fetal malpresentation and easily fetal parts were palpated. Diagnosis was missed during ante natal period. The eminent signs were client’s history and flat abdomen x-ray which revealed the fetal demise. At first client was managed conservatively including induction of labor with oxytocin which failed. Later surgical intervention (Laparotomy) was performed and a dead fetus was extracted from the abdominal cavity. Umbilical cord was cut at its insertion to the placenta leaving the placenta in situ for its natural autolysis. On inspection intra-operatively the uterus, the left fallopian tube and both ovaries were intact and normal while the right fallopian tube was not identifiable. Post operative period and later follow up of the mother was awesome.

Conclusion

Diagnosis of abdominal pregnancy is missed during antenatal care despite the use of modern diagnostic tools like Ultrasonography, Magnetic resonance imaging etc as in many cases the exact location of the fetus and its size are not ascertained. High index of suspicion is needed to make first diagnosis of abdominal pregnancy. This case report is presented to draw attention to obstetrics and/or midwifery care providers the challenges related to diagnosis and its management to prevent life threatening complications in poorly resourced centers.