Advanced abdominal pregnancy--observations in 10 cases

Advanced abdominal pregnancy was encounter 10 times in 102,000 deliveries over a period of 10 years at 1 hospital. The clinical features, difficulties in diagnosis and management, and the outcome of this uncommon condition are discussed. The most frequent symptoms encountered in this series were abdominal pain (100%), nausea and vomiting (70%), general malaise (40%), and painful fetal movements (40%). The commonest physical findings were abdominal tenderness (100%), an abnormal fetal lie (70%), and a displaced uterine cervix (40%). The incidence of diagnostic error was 60%. Multiple diagnostic procedures are needed to reduce the incidence of error. The maternal mortality was 20% and the perinatal mortality 40% in this series. The postoperative morbidity and mortality were high when the placenta was left in situ. Methotrexate was used in 5 cases to expedite degeneration of the trophoblastic tissue in the residual placenta. The value of this drug in managing the abdominal placenta could not be established. Removal of the placenta, when it is safely possible, gives the best results.