Advanced abdominal pregnancy: a search for consensus. Review of literature along with case report

Abstract

Advanced abdominal pregnancy is a highly morbid form of extrauterine gestation that demands skilled management. Despite advancement in antenatal care and imaging modalities, undiagnosed cases of advanced abdominal pregnancies are still reported. We report a case of asymptomatic abdominal pregnancy with healthy fetus advanced till 40 + 4weeks period of gestation. Her diagnosis was not established even after obstetrical evaluation and cesarean section at primary care hospital. To the best of our knowledge, less than 10 postdated cases of abdominal pregnancy have been reported so far in the literature. This case emphasizes the need to re-awaken awareness and high index of suspicion to diagnose such cases. Details of all the cases pertaining to advanced abdominal pregnancies reported after 2013 were reviewed and summarized. We searched electronic medical database in English using keywords related to abdominal pregnancy. Bibliographies of the relevant articles of advanced abdominal pregnancy published from 2013 onwards were reviewed and then cross searched to identify further relevant studies. A total of 26 cases of advanced abdominal pregnancy including index one were reviewed. All preoperatively diagnosed cases of abdominal pregnancy at earlier gestation were given conservative management and resulted in live births. The incidence of malformations in live births was 24%. We are of considered opinion that conservative strategy is a feasible option in selected cases of advanced abdominal pregnancy yet there is a need of standardization of treatment principles for such cases to optimize fetomaternal outcome.