Advanced abdominal pregnancy is a rare entity demanding high index of suspicion for diagnosis and has challenging management. It is associated with a high maternal and perinatal mortality. The key to favourable maternal outcome is early diagnosis and management. A case of an advanced abdominal pregnancy in a multigravida is presented. Clinical presentation and ultrasound were suspicious of abdominal pregnancy, which was confirmed at laparotomy resulting in delivery of a term alive male baby. It turned out to be secondary abdominal pregnancy.
Keywords: Abdominal Pregnancy, Laparotomy, Abdominal Pain.
About 2% of all pregnancies are ectopic, accounting for 10% of all pregnancy related deaths. More than 95% of ectopic pregnancies occur within the fallopian tubes. Abdominal pregnancy, a rare variety of ectopic pregnancy, is defined as an intra-peritoneal implantation that is exclusive of tubal, ovarian or intraligamentous implantation. The worldwide incidence ranges from 1:3300 to 1:10,200 births and accounts for 1 to 4% of all ectopic pregnancies. Even more uncommonly does it reach an advanced stage of gestation, and a viable abdominal pregnancy with a successful outcome is a rare event.1
The incidence varies widely with geographical location, degree of antenatal attendance, level of medical care and socio-economic status. It is believed that abdominal pregnancy is more common in developing countries, probably because of the high frequency of pelvic inflammatory disease in these areas. The condition is associated with very high maternal mortality with reported rates of 0.5 to 18%. The major cause for this is massive haemorrhage which may occur during pregnancy, intra-operatively or in the post operative period. Similarly, the condition is associated with very high perinatal mortality rate of 40-95%.
The diagnosis of abdominal pregnancy is difficult and requires a high index of suspicion.2 Symptoms and signs such as abdominal pain, vague gastrointestinal symptoms, painful fetal movements, abnormal fetal presentation, uneffaced and displaced cervix, vaginal bleeding, palpation of pelvic mass distinct from the uterus, inability to stimulate uterine contractions with oxytocin are considered suggestive evidences of an abdominal pregnancy.
A case of advanced abdominal pregnancy is reported which was managed successfully by laparotomy resulting in delivery of a term, alive male baby.
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