Advanced abdominal pregnancy--a review of 23 cases

Twenty-three cases of advanced abdominal pregnancy were managed at Harare Hospital, Zimbabwe, over a 10 year period. The incidence was 1 in 9500 total deliveries and 1 in 60 ectopic pregnancies. There were no maternal deaths but perinatal mortality was 83%. Of the 5 liveborn infants, 4 had pressure deformities and 3 were small for gestational age. There was one neonatal death due to pulmonary hypoplasia. Diagnosis is difficult and is often first suggested by failed induction of labour in a case of presumed intrauterine death. Abnormal presentation of the fetus, displacement of the cervix and anaemia were the most common clinical features. At operation, haemorrhagic shock occurred more frequently when attempts were made to remove the placenta. However, the average post-operative stay of patients who had placental tissue left was 22.4 days compared with 8.3 days for those who had the placenta removed. It is recommended that the placenta be removed only if its entire blood supply can be ligated. Partial removal of the placenta is the most hazardous procedure and should not be undertaken.