Diagnostic and management dilemmas in secondary abdominal pregnancy: A case report and literature review of 314 cases from 1930-2021

Author(s): Nehal Machado, Akhila Vasudeva, Sunanda Bharatnur, Swati Kanchan

Objective:

This study aims at highlighting diagnostic and management dilemmas in secondary abdominal pregnancy.

Methods:

We report a primigravida at 13 weeks gestation who presented with vague abdominal pain. Imaging confirmed secondary abdominal pregnancy with hemoperitoneum. Emergency laparotomy revealed significant hemoperitoneum, a live floating fetus in the abdominal cavity and placental attachment to the left cornu and fallopian tube which were removed and cornual repair performed. We reviewed the literature on secondary abdominal pregnancies, early and advanced from 1930-2021 and summarised management and outcomes of 314 such cases. Results:

Of the 314 cases, 295 (93.9%) were surgically managed and 19 (6%) required hysterectomy. Complete placental removal was achieved in 264 cases (84%), partial in 27 (8.6%) and left in situ in 16 (5.1%). Seventyfour cases (23.6%) required blood transfusion. There were 15 maternal deaths (4.8%).

Conclusion:

Maternal mortality and morbidity is of serious concern in abdominal pregnancies requiring a high index of suspicion and management expertise.