[A full-term second abdominal pregnancy]

Area of Science:

• Obstetrics and Gynecology
• Reproductive Medicine
• Surgical Case Reports

Background:

• Abdominal pregnancy is a rare complication of ectopic pregnancy, posing significant risks to both mother and fetus.
• A history of tubal pregnancy and procedures like salpingectomy can alter pelvic anatomy, potentially influencing pregnancy implantation sites.
• Early diagnosis of abdominal pregnancy is challenging, often requiring a high index of suspicion, especially in patients with prior reproductive surgeries.

Observation:

• A 27-year-old patient with a history of right salpingectomy for tubal pregnancy presented with suspected imminent abortion between 22-28 weeks gestation.
• Initial clinical and ultrasound findings suggested an intrauterine pregnancy, but later symptoms indicated abdominal pregnancy.
• An oxytocin challenge test was negative.

Findings:

• Laparotomy revealed a viable fetus in an abdominal pregnancy. A healthy female infant weighing 3200g was delivered.
• The placenta was found attached to the anterior uterine wall and the outer aspect of the right uterine horn, which had an opening at the site of previous oviduct excision.
• Severe hemorrhage occurred post-delivery, leading to a diagnosis of uterine rupture and necessitating a supravaginal hysterectomy.

Implications:

• This case highlights the possibility of abdominal pregnancy following salpingectomy and underscores the diagnostic challenges, even with prior imaging.
• It emphasizes the critical need for vigilant monitoring and prompt surgical intervention in suspected cases of advanced abdominal pregnancy.
• The management required highlights the potential for severe maternal morbidity, including hemorrhage and the need for hysterectomy, in complex ectopic pregnancies.