Advanced abdominal pregnancy: case report and review of 163 cases reported since 1946

Abstract

Context: Though relatively rare, advanced abdominal pregnancy (AAP) can have dramatic and catastrophic consequences for the foetus and the mother. Difficult to diagnose pre-operatively, AAP presents special challenges to the physician working in remote areas with limited resources for diagnosis and management.Issue: Case report: A case of AAP received in our hospital in Kolofata, Cameroon, is presented and followed by a review of 163 other cases reported from 13 countries since 1946. Lessons learned:A physician working in a remote district with an active maternity service should expect to encounter several cases of AAP during his or her working lifetime. Pre-operative diagnosis of AAP allows time for thoughtful preparation of the patient, family and medical team; however, to be diagnosed, AAP must first be considered. Diagnosis requires a high index of suspicion, and this should be triggered by any of a number of symptoms and signs reported in many cases of AAP. An unusual echographic appearance of the placenta was present in our case and prompted a more thorough investigation that confirmed the diagnosis. This finding has been reported by others and should be added to the list of signs and symptoms that might lead to a diagnosis of AAP in time to save the surgeon from an unpleasant and dangerous surprise.

Advanced abdominal pregnancy: challenges, update and review of current management

“…Neonatal deaths secondary to prematurity, pulmonary hypoplasia, severe deformities and chorioamnionitis were reported in 25 cases. The perinatal mortality rates reported in the literature range from 72–83% 6,30,35 . The review of fetal outcomes by Stevens (1993) 7 suggests that advances in maternal and neonatal care have led to better survival, with 78% survival rate of live born infants born beyond 30 weeks of gestation in 1971–1990 compared with 55% before 1933.…”

“…Despite focused antenatal care and advances in ultrasound technology, only around half of all cases are diagnosed preoperatively. 4,6 There are no specific symptoms or signs of AAP. The commonest presentation is abdominal pain with or without vaginal bleeding.…”

“…AAP is theoretically preventable, but the absence of consistent clinical features and a lack of clinician suspicion mean the diagnosis is frequently missed. Despite focused antenatal care and advances in ultrasound technology, only around half of all cases are diagnosed preoperatively 4,6 …”

“…1 With advances in obstetric care, particularly those relating to management of massive haemorrhage and neonatal care, survival has improved. Recent estimates of maternal mortality are 0-12%, [4][5][6] and fetal survival is over 78%. 7 ª 2022 Royal College of Obstetricians and Gynaecologists.…”

“…Several case series and literature reviews report rates of 0-5%, 4,5,30,35,40,43 while in a review of 163 cases in 13 countries between 1946 and 2008, the rate was 12%. 6 The overall risk of death has been estimated at 7.7 times that of tubal ectopic pregnancy and 90 times that of an intrauterine pregnancy. 1 There were eight recorded maternal deaths found in our literature search; seven of these at gestations beyond 26 weeks and secondary to haemorrhage, sepsis and pulmonary embolism.…”