Advanced primary abdominal pregnancy with a live birth: a case report

Area of Science:

• Reproductive Medicine
• Maternal-Fetal Medicine
• Surgical Obstetrics

Background:

• Advanced primary abdominal pregnancy is exceptionally rare, presenting significant diagnostic hurdles and risks for mother and baby.
• Management strategies lack evidence-based protocols, relying on clinical judgment and case reports.
• This condition necessitates careful consideration due to potential severe complications.

Purpose of the Study:

• To report a case of advanced primary abdominal pregnancy in a primigravida.
• To illustrate the successful management of this rare obstetric emergency.
• To emphasize the importance of a multidisciplinary approach in achieving favorable outcomes.

Main Methods:

• A 26-year-old primigravida at 31 weeks gestation presented with an asymptomatic advanced abdominal pregnancy.
• Diagnostic imaging (ultrasonography and MRI) confirmed extrauterine fetus, oligohydramnios, and ureteric compression.
• Management involved ureteric stenting, laparotomy for delivery, leaving the placenta in situ, and postoperative chemotherapy (methotrexate/folinic acid).

Main Results:

• A live female neonate was delivered at 32 weeks gestation.
• The placenta was intentionally left in situ due to extensive vascularity and critical attachments.
• Postoperative chemotherapy led to progressive placental regression with an uneventful maternal recovery.

Conclusions:

• Accurate preoperative diagnosis is crucial for managing advanced abdominal pregnancy.
• Early multidisciplinary team involvement is vital for optimal patient care.
• Meticulous intraoperative and postoperative management can lead to favorable maternal and neonatal outcomes in rare obstetric conditions.