Successful outcome of advanced abdominal pregnancy with exclusive omental insertion.

Abstract

We report the case of an advanced abdominal pregnancy with exclusive omental insertion whose extrauterine location was not established until delivery by Cesarean section at 35 weeks' gestation. It is hard to believe that omental placentation alone would be sufficient to sustain a pregnancy beyond a gestation where the fetus is viable. However, this report challenges such myths and opens the debate as to what represents the minimal placental maternal viscus contact necessary to achieve fetal viability. The case also demonstrates the continuing difficulty in diagnosing this rare but serious condition despite advances in obstetric imaging, and advocates methods to avoid missing the diagnosis, which could be easily incorporated at booking and mid-trimester scans. Apart from this case, few reports describe normal umbilical artery Doppler velocimetry in advanced abdominal pregnancy. There is a paucity of research on suitable clinical investigations prognostic for abdominal pregnancy, although this case provides further evidence for the use of Doppler as a useful surveillance tool in such cases. Finally, this case propagates the ethical and clinical controversy that exists in managing abdominal pregnancy, particularly when diagnosed late after attaining fetal viability. Expectant management may represent a feasible alternative to surgical termination provided the woman is fully informed of the attendant risks and close surveillance of the pregnancy is undertaken.