Advanced extra-uterine pregnancy

Forty-three cases of advanced extra-uterine pregnancy of more than 34 weeks' gestation, seen and treated at Baragwanath Hospital between 1966 and 1978, are reviewed. The incidence in our unit was 1 per 6 389 deliveries. Abdominal pain and vaginal bleeding were the most common complaints. Simple vaginal examination is of great help in establishing the diagnosis, while the abdominal signs are found to be disappointing in this respect. The oxytocin test is a helpful diagnostic aid and various radiographic methods, such as plain X-ray abdomen, hysterosalpingography and ultrasonography have their merits. The placenta, although attached to rather critical areas in the majority of patients, was removed safely without damage to neighboring structures in 93% of the cases. Four patients, however, required hysterectomy. There were two maternal deaths. Of the 18 babies born alive, only 8 survived. All the surviving infants had congenital anomalies but only 5 had problematic defects.