Abdominal Pregnancy at 38 weeks with good maternal and perinatal outcome

Abstract

Introduction: Abdominal pregnancy is very rare form of ectopic pregnancy, associated with high morbidity and mortality for both fetus and mother. An advanced abdominal pregnancy with good fetal and maternal outcome is therefore more extraordinary occurrence in modern developed world.

Case: We present a case of abdominal pregnancy which was an emergency diagnosis on OT table while performing elective LSCS for 38 weeks with breech with previous LSCS with normal documented prenatal sonographies (Fig S6, S7). It is extremely rare to first diagnose abdominal pregnancy at the time of elective caesarean section for another indication.

Management: Post delivery of baby by breech extraction, torrential bleed and massive hemorrhage from placenta adhering to bowel and omentum was big challenge. Provisional differential diagnosis was that of placenta percreta. This led team to follow emergency hemorrhage protocol of laparotomy, total abdominal hysterectomy under blood and blood products coverage with intravascular volume expanders.

At the time of laparotomy the fetus was located in the pelvis covered by the amniotic sac, with distortion of the entire right adnexa and invasion to the right parametrium and the right side pelvic wall. The placenta invaded the pouch of Douglas, the omentum and the bowel on right pelvic wall. Massive hemorrhage was a challenge and was dealt with successfully (fig 1). Injection methotrexate (50 mg) was used to expedite degeneration of the trophoblastic tissue in the residual placenta.