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Advanced primary abdominal pregnancy – A case series based on single-center experience from a rural secondary level hospital in Northeast India

Five patients with advanced primary abdominal pregnancy presented to our center between 2010 and 2020. The clinical profile, presentation, and management of these patients are described with a discussion on this rare but important condition. Of the five, four women survived. There was preoperative fetal demise in four of them, and one patient had a healthy live term baby. Advanced primary abdominal pregnancy, although very rare, is a life-threatening variation of ectopic gestation. Correct diagnosis is often a serious obstetric dilemma and the condition is associated with a 90-fold increase in maternal mortality rate and fetal survival is exceedingly rare. The clinical symptoms by which patients present are similar to other ectopic pregnancies like tubal ectopics. However, in our subset of patients, all were in their third trimester and four out of five presented in shock. Hence, a high degree of clinical suspicion for abdominal pregnancy is required to clinch a correct diagnosis. Often, the diagnosis of abdominal pregnancy is made only during laparotomy. Preoperative ultrasound has 50% accuracy in diagnosing this condition. Magnetic resonance imaging is considered gold standard for the diagnosis of abdominal pregnancies. Medical management with methotrexate is opted when the site of abdominal pregnancy is in the liver and spleen where life-threatening hemorrhage is expected. Surgical management is considered in patients with severe intraperitoneal hemorrhage and in second- and third-trimester abdominal pregnancies. Early diagnosis and proper surgical management irrespective of the stage of gestation is important for achieving good outcome.