Term Abdominal Pregnancy with a Live Fetus Incidentally Found During Cesarean Section: A Case Report

Abdominal pregnancy is a rare but, serious obstetric condition that has continued to pose difficulties in its diagnosis and management. The clinical presentation takes various forms, mostly nonspecific, leading to the delay in diagnosis and management. With a high degree of suspicion, the diagnosis can be made by an abdominal ultrasound particularly in the early trimesters. The objective of this case report is to share our experience in low resource setting dealing with this rare condition diagnosed incidentally during a planned Cesarean section for another obstetric indication.

Twenty-five-year-old primigravida from the Federal Republic of Somalia at a gestational age of 37 + 3 weeks was admitted for elective cesarean section with a diagnosis of Placenta Previa. She had frequent antenatal visits to nearby health facilities with non-specific abdominal symptoms and spotty vaginal bleeding. Intraoperatively, the uterus and right adnexa were normal, while the fetus, chorioamniotic membrane, and placenta were found in the peritoneal cavity and the diagnosis of abdominal pregnancy was made. A 3.5kg live female fetus was delivered with Apgar score of 9 and 10 in the 1^st and 5^th minutes. Placenta removed through infracolic omentectomy and left adnexectomy. The neonate had facial deformity, bilateral club foot, scoliosis and finger deformities. The mother discharged in good health on the 10^th post-operative day and the neonate was linked to orthopedic surgeon for further management.

This case report demonstrates the continuing challenges in early diagnosis and management of this serious obstetric condition. The rarity of the condition in general, and in low resource settings delayed antenatal care (ANC) booking of women, and lack of experience in meticulous ultrasound scanning, are challenges in making an accurate diagnosis. It is recommended that the location of pregnancy should be confirmed in early trimester, vague and nonspecific complaints should be addressed to rule out or rule in ectopic pregnancy.