Lessons learned from four advanced abdominal pregnancies at an East African Health Center

Abstract

To analyze diagnosis and treatment of four advanced abdominal pregnancies in a low-resource setting of a developing country. Extrauterine pregnancies occurring between 1997 and 2003 were identified from hospital records of the Mikumi Health Center in Tanzania/East Africa. A total of 45 extrauterine pregnancies were diagnosed four of which were advanced and located in the abdominal cavity. At the time of diagnosis, pregnancies were at 33, 34, 36 and 39 weeks of gestation, respectively. All four mothers survived but three of four fetuses died. One child is alive and well three years after delivery. Abdominal pregnancy is rather difficult to detect in a low-resource setting of a developing country. Persistent abdominal pain and tenderness, as well as fetal movements in the upper abdomen associated with abnormal fetal lie, may lead to its diagnosis. Localizing the fetal heart sounds in the maternal epigastrium especially in patients with abdominal pain may also be helpful in diagnosing an abdominal pregnancy. In addition, the lack of cervical changes or a displaced cervix should lead to the suspicion of an abdominal pregnancy.