Managing Maternal Sepsis after Delivering an Advanced Abdominal Pregnancy in Low Resource Setting Health Facility

Abstract

Background: Abdominal pregnancy is a rare form of ectopic pregnancy with a higher misdiagnosis rate. Sepsis is a life-threatening complication associated with this type of ectopic pregnancy. Various techniques for managing septic advanced abdominal pregnancy have been discussed in the literature. In this article, we report a case of managing septic abdominal pregnancy in which a macerated baby was delivered, and the necrotic placenta was left in situ. Case presentation: We report a 34-year-old African woman, para 5 living 4, who was three days post laparotomy due to abdominal pregnancy. A re-laparotomy was done due to maternal sepsis. The peritoneum had foul-smelling pus, with a necrotized placenta which was still attached to various parts of the abdomen. The placenta was left in situ and the abdomen was left open. Pus swab revealed methicillin-resistant staphylococcus aureus which was sensitive to Vancomycin. She was managed with a ten-day Vancomycin regime. Dressing with normal saline and honey twice or thrice a day for eight weeks was done. Secondary suturing was done and the patient was discharged home later in good health. Conclusion: Advanced abdominal pregnancy is a rare condition, and its management is very challenging. Once it complicates into maternal sepsis the life of the mother becomes endangered. Identifying and treating the source of infection with daily dressing using normal saline and honey is simple and cheap, it saves life.