Data collection and analysis-
An illustrative case report of a woman at 13 weeks gestation referred
from a primary health centre 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. Recovery
was uneventful.
We reviewed the literature on secondary abdominal pregnancies, early and
advanced from 1930-2021 and summarised management and outcomes of 314
such cases.
Main Results- Among the 314 cases reviewed, 295 cases
(93.9%) were surgically managed and 19 (6%) required hysterectomy.
Post-surgery methotrexate was given in 9 cases (2.9%). Following
primary methotrexate administration in 18 patients, 10 required surgery
(55.5%). Complete placental removal was achieved in 264 cases (84%),
partial in 27 (8.6%) and left in situ in 16 (5.1%). Seventy-four cases
(23.6%) required blood transfusion. There were 15 maternal deaths
(4.8%).
Twenty-seven fetuses (8.6%) were live born, 6 (1.9%) were neonatal
deaths and 46 (14.6%) were fetal demise.
Conclusion- Maternal mortality and morbidity is of serious
concern in abdominal pregnancies requiring a high index of suspicion and
management expertise.
Funding- None