Advanced abdominal pregnancy at a tertiary hospital in South Africa: a case series

Advanced abdominal pregnancy occurs when the products of conception implant within the peritoneal cavity, external to the fallopian tubes and myometrium, beyond 20 weeks gestation. This is a rare condition that typically carries high maternal and neonatal mortality and morbidity especially in low middle income countries.

To describe the outcomes of advanced abdominal pregnancies over 14 years at a tertiary neonatal unit.

This case series retrospectively analyzed 17 extrauterine pregnancies at Groote Schuur Hospital in Cape Town, South Africa. Seventeen mothers and 18 babies were included in the analysis. Data analysis focused on maternal history, risk factors, delivery complications, intraoperative findings, and neonatal outcomes. Microsoft StatPlus was used for statistical calculations.

Of the 17 pregnancies, 16 were singleton births and one was a set of monochorionicmonoamniotic twins. In 14 cases (82.4%-14/17), the diagnosis was missed on the initial ultrasound scan. Sixteen (94.1%-16/17) deliveries were expedited within 48 hours of diagnosis. All deliveries were performed via open laparotomy under general anesthesia. There were 2 maternal deaths, and all cases involved at least 1 maternal complication. Thirteen (76.5%-13/17) placentae were implanted on multiple sites including the uterus, adnexa, omentum and bowel. Of the 18 babies, 12 (66.7%-12/18) were born alive, with 1 early and 1 late neonatal death. The median birth weight of live-born babies was 1313 grams (interquartile range: 970-2250 g). The median Apgar score was 5 (interquartile range: 3-6) at 1 minute and 7 (interquartile range: 4-8) at 5 minutes. Two (16.7%-2/12) babies had transient cranial asymmetry. The median length of hospital stay for the ten babies discharged home was 32 days (interquartile range: 19-41 days).

Advanced abdominal pregnancies, when detected early and managed at well-resourced tertiary hospitals, can result in favorable outcomes. This is the first case series from a low- and middle-income country demonstrating such positive neonatal outcomes.