Unexpected Advanced Abdominal Pregnancy from a Placenta Previa Suspicion: A Case Report

Abstract

Advanced abdominal pregnancy is a condition of pregnancy that continues beyond 20 weeks of gestational age in the abdominal cavity. Estimation of the case occurrence is between 1:10,000 to 1:30,000 live birth. This happens as a result of fertilization in abdominal cavity, tubal rupture, or tubal abortion. This condition causes a high morbidity and mortality rate in the mother and baby. We presented a case of a 41-year-old woman with G2P1 term pregnancy referred to our OBGYN clinic in Dr. Zainoel Abidin Hospital, Banda Aceh, from a regional hospital with morbidly adherent placenta previa with no suspicion to abdominal pregnancy. She had no history of antepartum hemorrhagic. The patient was put through several examinations and prepared for elective c-section to hysterectomy. After opening the peritoneum during C-Section, we had difficulty identifying the lower segment of the uteri. The amniotic membrane was covered with omentum. We incised the amniotic membrane and delivered a 3500gr, AS 8/9 male baby. Placental implantation was identified at the omentum, uterine fundus, and some of the pelvic wall. Bleeding was controlled and a large part of the placenta was evacuated adequately, but some part was left in the abdominal cavity. The patient's and the baby's condition were stable after the surgery and was discharged after the fifth day of hospitalization in a good condition. This case report provided insights that advanced abdominal pregnancy shows no typical symptom and is similar to placenta previa. Its diagnosis at an advanced gestational age is apparently more challenging. Some cases were able to be diagnosed preoperatively, but most other cases were only diagnosed intraoperatively.