A 25 year old primigravida woman whose gestational age from LNMP was 25 weeks plus six days presented for the first time with a chief complaint of involuntary abdominal movement of three weeks duration. She stated that three weeks prior to her presentation to the clinic she had experienced involuntary, rhythmic and painful abdominal movement (Supplementary Video 1) (Supplementary Video 2) which started suddenly and stays for 30-120 seconds and happens 3-5 times per day.
Most of the time, it starts while she was eating food and stops when she was breathing deeply and distracted. Other than these she did not find any predisposing, exacerbating or relieving factors. She presented to the antenatal clinic with these complaints and on arrival the obstetrician had also noticed the rhythmic involuntary abdominal movement as showed in the Supplementary Videos 1 and 2. She denied the use of any medication preceding the involuntary abdominal movement except ferrous sulphate given during ANC visit. She never had any gynecologic and surgical procedure before. Different laboratory and imaging investigations were done for her. These are renal function test, liver function test, thyroid function test, electrolytes, HIV, Venereal Disease for Research Laboratory (VDRL) and CBC and all were within the normal limit. Ultrasound examination revealed 27 weeks singleton intrauterine pregnancy without any abnormal finding. Imaging like MRI, EEG and EMG was not done since it is not available in this locality (Harar) and it was difficult for her to go to the capital city of the country (Addis Ababa) which is 580 kilometers away from Harar town where these imaging services are available.
On physical examination vital signs and all the system examination were unremarkable except the abdominal examination which shows a 26 week sized gravid uterus with positive fetal heartbeat. She was diagnosed with belly dancer dyskinesia and diazepam was prescribed but she refused to take it.
At 38 weeks plus five days she was diagnosed with preeclampsia with severity features after she presented with severe headache of two days duration and her BP was 150/100 mmHg for which cervical ripening and induction was started. After 10 hours of total induction time there was no contraction, so she was taken to operation theater and undergone cesarean section for the indication of failed induction to result in delivery of a 4000 g female live neonate who cried immediately after delivery. She was discharged after 48 hours post-cesarean section hospital stay with good post-partum condition and a healthy neonate.
During the post-partum period, she did not have this abnormal movement and 6 months after her first delivery, she came to the clinic for antenatal follow-up after she had an unplanned but wanted pregnancy. Her second pregnancy antenatal follow-up was uneventful without any abnormal symptom unlike the previous pregnancy. At 39 weeks of pregnancy from her early ultrasound she underwent elective cesarean section for the indication of short inter-pregnancy interval and previous cesarean section. After two postpartum days of hospital stay, the mother and neonate were discharged healthy.