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Term viable abdominal pregnancy: a case report and review

A 33-year-old gravida 2 para 0 who had had one previous abortion was admitted to a peripheral hospital because of labour pains at 39 weeks' gestation. The attending medical officer diagnosed the fetus to be in an oblique lie and the patient was referred to the Queen Elizabeth Hospital in anticipation of difficult surgery. She had been examined at 19 weeks for amenorrhoea, when an ultrasound scan confirmed fetal parameters conforming to her dates. The placenta was documented to be in the fundal region. Subsequent antenatal visits were uneventful. On arrival at Queen Elizabeth Hospital she was noted to be in pain, but with stable vital signs. Abdominal examination revealed a term-sized gravid uterus with the fetus in an oblique lie. A tubular closed cervix was noted on pelvic assessment and she was scheduled for an emergency Caesarean section. Intraoperatively, an abdominal pregnancy was diagnosed. The placenta was attached to the right posterolateral aspect of the uterus and the right broad ligament. It then extended to the right pelvic wall, ending at the posterior abdominal wall and partially involving the omentum. A live 3200 g baby girl was delivered with an Apgar of 9/10 at one minute. However, inadvertent separation of the placenta from its uterine and pelvic wall attachments resulted in profuse haemorrhage. The bulk of the placenta was removed after multiple transfuring ligation sutures and a partial omentectomy was done. There was profuse bleeding &om the raw uterine surface and an immediate recourse to hysterectomy was made after all conservative measures failed to contain the haemorrhage. Abdominal packs were inserted and a large bore tube-drain placed. Estimated blood loss was 3.5 litres. A total of seven units of whole blood and 11 blood product units were transfused. After 48 hours in intensive care