Late abdominal pregnancy in a post-conflict context: case of a mistaken acute abdomen - a case report

Paluku, Justin; Kalole, Benjamin Kambale; Furaha, Cathy Mufungizi; Kamabu, Eugénie Mukekulu; Mohilo, Gaspard Makambo; Kataliko, Benjamin Kasereka; Bartels, Susan A.

doi:10.1186/s12884-020-02939-3

Cited by 14 publications

(12 citation statements)

References 12 publications

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“…14,35 Although it is not uncommon for the diagnosis to be made intra-operatively both in women who had no prior ultrasound conducted and those with a history of repeated ultrasounds. 14,15,36,37 This further supports the need for high index of suspicion among clinicians when making a diagnosis of abdominal pregnancy.…”

Section: Discussionmentioning

confidence: 64%

Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report

Mushema¹,

Nkwama

Rweyemamu

et al. 2022

EAHRJ

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Background: Abdominal pregnancies are a rare occurrence and are associated with high maternal and perinatal mortality rates compared to intra-uterine and other ectopic pregnancies. Localization of sites of abdominal pregnancies and determining the gestational age at the time of diagnosis play a fundamental role in guiding the treatment approach and minimizing potential complications. However, the vague presentation coupled with low accuracy of ultrasound detection often leads to misdiagnosis of abdominal pregnancy, and hence delaying initiation of appropriate management. We present a case of a second trimester abdominal pregnancy detected following failure of induction for an initial diagnosis of missed abortion, and the ensuing outcome, rarely reported in limited-resource settings. Case presentation: A 19 year old unbooked woman, gravida 2 para 1 at 17thweek gestation age by ultrasound presented with loss of foetal movement for one week. Based on clinical assessment and referral ultrasound findings, she was initially diagnosed with missed abortion and planned for induction. Failure of induction prompted a repeat ultrasound which revealed a non-viable abdominal pregnancy. Laparotomy was done, localisation of the pregnancy at the omentum was observed and a dead foetus was extracted with the placenta left in-situ. A complication of surgical wound dehiscence with infection developed post-operatively and was managed with secondary sutures. The patient recovered and was discharged in a stable condition. Conclusion: This case demonstrates that the diagnosis of abdominal pregnancy remains a challenge especially in settings where skilled human resources for health are few and equipment and supplies for effective and timely treatment are limited. The case sheds some light on the broader challenges in maternal and perinatal health in developing countries. Accurate pre-operative diagnosis requires a high index of suspicion, especially due to the variability of its presentation. This case emphasises the important of quality antenatal care and the need for clinicians to conduct comprehensive assessments of patients and receive training on obstetric ultrasound skills.

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Section: Discussionmentioning

confidence: 64%

Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report

Mushema¹,

Nkwama

Rweyemamu

et al. 2022

EAHRJ

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“…This happened to be unruptured cases probably because of the wide space in the abdomen and in most cases, rich blood supply. 29 In our study, surgery remained the mainstay of treatment of EP. This was done mainly by salpingectomy.…”

Section: Discussionmentioning

confidence: 77%

A decade study of the incidence and clinical analysis of ectopic pregnancy at a tertiary hospital in Eastern Nigeria

Chukwu

Agulanna

Okafor

et al. 2022

Int J Reprod Contracept Obstet Gynecol

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Background: Ectopic pregnancy (EP), a condition where a fertilized egg grows outside a woman’s uterus, is a fertility- and life-threatening gynecological condition. This study aimed at determining the incidence of EP, clinical presentation, gestational age at presentation, risk factors and treatment modalities.Methods: This study was conducted at St. Charles Borromeo specialist hospital, Onitsha, Nigeria (January 2009 to December 2018). Information were obtained from the hospital’s medical records as retrieved from various wards. Data were analyzed using IBM SPSS, version 23, then presented as percentage in tables and figure.Results: Out of 13,402 pregnancies recorded in this study, 119 were EPs giving an incidence of 0.89%. 105 case notes were included in this study since they met the inclusion criteria. Majority of the women belonged to the age group of 26-30 years. Patients with EP presented more between 7-8 weeks of gestational age (40%), though 7.6% were unsure of their last menstrual period. 80 EP cases (76.2%) were ruptured while 25 (23.8%) were unruptured. The ectopic gestation occurred most at the ampulla (51.4%) and more at the right side (66.6%) than the left (33.4%). Pelvic inflammatory disease (30.4%) followed by prior abortion (20.0%) were major predisposing risk factors. The most common clinical presentations were abdominal pain (92.38%), amenorrhea (57.14%) and vaginal bleeding (51.42%). 85.7% had salpingectomy, 9.5% were medically managed.Conclusions: EP remains a major gynecological emergency. Diagnosis before rupture could offer an opportunity for a successful medical management, thereby; minimizing morbidity and mortality.

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“…5,[29][30][31] The pain is often persistent throughout the pregnancy and exacerbated by fetal movements, potentially associated with the lack of uterine wall cushioning. 32 Masukume 33 describes the conservative management of a patient with intermittent abdominal pain from 8 weeks of gestation. The subsequent diagnosis of AAP was only made at 40 weeks of gestation, following admission with 3 days of constant periumbilical pain.…”

Section: Risk Factorsmentioning

confidence: 99%

“…The commonest presentation is abdominal pain with or without vaginal bleeding 5,29–31 . The pain is often persistent throughout the pregnancy and exacerbated by fetal movements, potentially associated with the lack of uterine wall cushioning 32 . Masukume 33 describes the conservative management of a patient with intermittent abdominal pain from 8 weeks of gestation.…”

Section: Clinical Presentationmentioning

confidence: 99%

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

McDougall

Morin

Kuzmich

et al. 2022

The Obstetric & Gynaecologis

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Although extremely rare, advanced abdominal pregnancy (AAP) is associated with considerable maternal and fetal morbidity and mortality. However, when diagnosed early and managed appropriately, it is possible to have successful outcomes. There are no specific criteria to diagnose AAP and it may be missed on ultrasound. Magnetic resonance imaging is the gold standard for evaluating placental implantation and preoperative planning. Management depends on the gestational age at diagnosis, with consideration of termination, preterm delivery and conservative management until further fetal maturation. Multidisciplinary preoperative planning is paramount for optimal outcome. Delivery is recommended in a tertiary centre with access to interventional radiology. Management of the placenta depends on the degree of penetration and the organ in which it embeds. Where the risk of removal increases the risk of maternal morbidity, it may be left in situ. Learning objectivesTo outline the classification of AAP. To understand the diagnostic challenges and the role of imaging in preoperative assessment. To describe the different management options and associated ethical issues. Ethical issuesThere is no established guidance for the diagnosis and management of AAP. AAP requires careful evaluation when deciding whether to terminate the pregnancy or provide expectant management. Informed consent requires acknowledgement of the considerable risks.

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Late abdominal pregnancy in a post-conflict context: case of a mistaken acute abdomen - a case report

Cited by 14 publications

References 12 publications

Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report

Challenges in Diagnosis and Management of Second Trimester Omental Pregnancy in Limited Resource Settings: Case Report

A decade study of the incidence and clinical analysis of ectopic pregnancy at a tertiary hospital in Eastern Nigeria

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

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