Laparotomy for Advanced Abdominal Ectopic Pregnancy

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Management of Pregnancy

Background:

• Abdominal pregnancy is the rarest and most severe form of ectopic pregnancy.
• Surgical intervention is the primary treatment for advanced abdominal pregnancies.
• Management of the placenta involves either removal or leaving it in situ.

Observation:

• A 26-year-old primigravida presented with a 9-month amenorrhea and absent fetal movement for one week.
• Despite two prior ultrasounds indicating a normal pregnancy, the patient had a 34-week-sized abdomen with palpable fetal parts but no fetal heartbeat.
• Examination revealed a closed cervix and mild abdominal tenderness.

Findings:

• Ultrasound confirmed a third-trimester abdominal ectopic pregnancy with a non-viable fetus.
• Laparotomy resulted in the delivery of a 2000gm macerated female stillborn from the peritoneal cavity.
• The placenta was successfully removed after releasing adhesions to the bowel and omentum.

Implications:

• Abdominal ectopic pregnancies can be missed even with repeated ultrasound scans, potentially progressing to the third trimester.
• A high index of suspicion, correlating patient signs and symptoms, is crucial for early diagnosis.
• Prompt surgical management is essential for advanced abdominal pregnancies to ensure maternal safety.