Abdominal pregnancy with healthy newborn: a rare incidence of ectopic pregnancy

Abstract

Abstract. he incidence of abdominal pregnancy is 1% of all the ectopic pregnancies. Abdominal pregnancy refers to a pregnancy that has implanted in the peritoneal cavity, external to the uterine cavity and fallopian tubes. As the diagnosis of abdominal pregnancy is often missed during routine ultrasonography. An empty uterus may be easily visualized. Case of a 34-year-old woman, Gravida 3 Para 1,was referred from district Hospital with an abdominal pregnancy. Her chief complaint was severe abdominal pain. Patient admitted 8 months of pregnancy. Her last menstrual period was 24/9/2018 with Estimated Date of Delivery 01/7/2019, correspond to 31-32 weeks of pregnancy. Her antenatal care was four times to OBGYN. Ultrasound examination results show the uterus within normal limits with positive endometrial line. Singleton live intra-abdominal pregnancy. It was decided to terminate the pregnancy by laparotomy exploration. Intra operative, found intra-abdominal fetus. Born female baby, with birth weight 1900 gram, Apgar Score 8/9. On exploration found the placenta was extensively adherent in intestinal organs. It was decided not to release the placenta from the implantation site, the umbilical cord was cut as short as possible from the placenta. The placenta was left in situ. Followed by the injection of single dose Methotrexate (MTX) post operative. Bleeding from placental implantation site is the most life-threatening complication during laparotomy. The decision to remove the placenta or not can be a determining factor for the survival of the patient. It is generally recommended to leave the placenta in situ and make a follow up with human chorionic gonadotropin levels.

Keywords— abdominal pregnancy, ectopic pregnancy, placenta, methotrexate