Antepartum Hemorrhage as Unusual Presentation of Advanced Abdominal Pregnancy

Temesgen Tilahun Bekabil

doi:10.4172/2161-0932.1000268

Abstract

Abdominal pregnancy carries higher maternal morbidity and mortality both in developed and developing countries particularly in resource limited settings. Its diagnosis is usually missed during antenatal care despite the routine use of abdominal ultrasonography. This case is presented to show that antepartum haemorrhage, one of antenatal complications of intrauterine pregnancy, can be the presenting clinical condition in advanced abdominal pregnancy and to demonstrate the continuing difficulty in diagnosing this rare but serious condition despite advances in obstetric care. The case also demonstrates how management of advanced abdominal pregnancy, particularly delivery of placenta, is difficult. In conclusion, it is important to have high index of suspicion of advanced abdominal pregnancy when antepartum haemorrhage is presented with other clinical clues of abdominal pregnancy due to the fact that making preoperative diagnosis of this form of pregnancy helps the managing team to be ready for grave complications of abdominal pregnancy at laparotomy and subsequently.

Highlights

Abdominal pregnancy refers to a pregnancy that has implanted in the peritoneal cavity, external to the uterine cavity and fallopian tubes [1,2]
The estimated incidence is 1 per 10,000 births and 1.4% of ectopic pregnancies [2,3]. It is associated with very high maternal morbidity and mortality, with the risk for death 7 to 8 times greater than from tubal ectopic pregnancy and 90 times greater than from intrauterine pregnancy, and with perinatal mortality ranging between 40 and 95% [4,5]
Due to its atypical presentation, advanced abdominal pregnancy creates dilemma for the managing obstetrician [7] and its diagnosis is usually missed during antenatal care, despite the routine use of abdominal ultrasonography [6]

Summary

Introduction

Abdominal pregnancy refers to a pregnancy that has implanted in the peritoneal cavity, external to the uterine cavity and fallopian tubes [1,2]. Due to its atypical presentation, advanced abdominal pregnancy creates dilemma for the managing obstetrician [7] and its diagnosis is usually missed during antenatal care, despite the routine use of abdominal ultrasonography [6]. She didn’t notice fetal movement for the last 2 months and she was having on and off type of abdominal pain but she didn’t visit health institution. Laparotomy was done and the diagnosis of abdominal pregnancy confirmed with intraoperative findings of empty uterus, dead fetus in the abdomen, calcified placenta implanted partly to omentum and partly to parenchyma of right ovary forming adhesion with right tube.

Findings

Discussion

Conclusion