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

Advanced primary abdominal pregnancy, an extremely rare condition, poses diagnostic challenges and carries a risk of serious maternal and perinatal complications. In the absence of evidence-based protocols, current management approaches are predominantly guided by anecdotal reports and individual clinical judgment. We report a case of primary advanced abdominal pregnancy in a primigravida.

A 26-year-old asymptomatic woman at 31 + 6/7 weeks' gestation was referred for routine third-trimester ultrasonography, which revealed a non-gravid uterus, a viable extrauterine fetus, oligohydramnios, and placental invasion of the right pelvic wall. Magnetic resonance imaging confirmed these findings and demonstrated placental compression of the right ureter with moderate hydroureteronephrosis. A multidisciplinary team was assembled. At 32 + 6/7 weeks, cystoscopic-guided ureteric stenting followed by midline laparotomy resulted in the delivery of a live female neonate. Due to extensive placental vascularity and critical attachments, the placenta was left in situ, and postoperative methotrexate alternating with folinic acid was administered to promote placental involution. The postoperative course was uneventful. Serial follow-up imaging showed progressive placental regression.

Even when facing a rare, challenging condition, favorable maternal and neonatal outcomes can be achieved through accurate pre-operative diagnosis, early involvement of a multidisciplinary team, thoughtful intra-operative decision-making, and meticulous post-operative care.