Full-Term Abdominal Pregnancy with Dead Fetus: A Case Report

Abstract

Introduction: Abdominal pregnancy is a rare form of ectopic pregnancy and is frequently misdiagnosed. Here, we report a full-term abdominal pregnancy with dead fetus in a case of second gravida. The diagnosis was missed despite regular antenatal care and was diagnosed intraoperatively. Case presentation: A 25 year old second gravida with a previous caesarean section was referred to us from a private hospital as a case of 38-week pregnancy with ruptured uterus. She had no other positive history except for an abdominal pain for 12 hours and loss of fetal movements for 6 hours. On examination, the abdomen was distended and tender, the uterus was well contracted and was palpable at the level of umbilicus and superficial fetal parts were felt. There were no fetal heart sounds and fetal movements were absent. On pelvic examination, the cervix was posteriorly placed with uneffaced and closed cervical os. Our patient underwent emergency exploratory laparotomy under spinal anesthesia and was found to have an intact, well-contracted uterus with the dead fetus lying in the peritoneal cavity surrounded by an intact amniotic sac. The placenta was attached to the greater omentum. The baby was extracted uneventfully. Mother had profuse blood loss during the procedure due to separation of abnormally implanted placenta. She was resuscitated with intravenous fluid and blood products. The postoperative period was uneventful and she recovered completely. Conclusion: Abdominal pregnancy poses special challenges to obstetricians working in remote areas with limited resources for diagnosis. A high index of suspicion is required in recognizing this condition in order to prevent adverse maternal and fetal outcomes.