A 27-year-old female, unbooked gravida 2 para 0 + 1 (previous salpingectomy). was referred to our health facility on account of ultrasound diagnosis of abdominal pregnancy at an estimated gestational age of 33 weeks and 5 days. Her history dated back to 6 months prior to presentation when she started having scanty bleeding per vaginam and slight abdominal pain after two missed periods. She presented to a traditional birth attendant (TBA) who sent her for a pelvic ultrasound scan. The ultrasound scan revealed an intra-abdominal pregnancy at an estimated gestational age of 9 weeks and 2 days. She was subsequently referred to a hospital for surgical management, but she decided to seek spiritual help from a traditional healer. The patient was not desirous of surgical intervention for the index ectopic pregnancy due to fear that it would jeopardize her future fertility potential.
Bleeding later subsided, and she continued her pregnancy care with the TBA until about 24 h prior to presentation when she started having severe generalized abdominal pain and fainting spells. The patient had a total of six ultrasound scans during the pregnancy which all revealed abdominal pregnancy.
On examination, she was severely pale; her pulse rate was 124 beats/min and blood pressure was 90/50 mmHg. Her abdomen was asymmetrically enlarged, and she had a well-healed Pfannenstiel scar. There was mild generalized tenderness, the symphysio-fundal height was 35 cm, and the baby was palpated to be in an oblique position in the maternal abdomen with the head in the left hypochondrial region and breech toward the right iliac fossa. The fetal heart rate was 142 beats/min. Vaginal examination revealed that the cervical os was closed and the pouch of Douglas was full.
Urgent packed cell volume (PCV) was 18%, and four units of blood were cross-matched. The patient had emergency exploratory laparotomy. A gastrointestinal surgeon and a neonatologist were present at surgery. Intraoperative findings were as follows: hemoperitoneum of about 1 L with clotted blood of almost 500 g; intraperitoneal gestational sac that was flimsily attached to the omentum [Figure 1]; clear-colored amniotic fluid of about 500 mL; a live female baby weighing 2.2 kg with APGAR scores of 4 at 1 and 7 at 5, the placenta was attached with a broad stalk to the left infundibulopelvic ligament, broad ligament, and also the left tube [Figures 2 and 3]; amputated right tube; atretic left ovary; grossly normal right ovary, and bulky uterus corresponding to about 16 weeks' size [Figure 4]. The fetus was delivered and showed no structural abnormality. The thick band connecting the placenta and infundibulopelvic ligament was clamped, ligated, and transfixed with vicryl 1 suture. The placenta was wholly delivered without any remnant left in situ. Abdominal drains were inserted into the left paracolic gutter and the pouch of Douglas. The patient had four units of blood transfused perioperatively, and posttransfusion PCV was 27%. The abdominal drains were removed on the 4th postoperative day.
The patient was counseled on the intraoperative findings and the need to present early whenever she missed her period. She was discharged on the 7th day postoperatively. The patient had three follow-up visits at 1 week, 3 weeks, and 6 weeks postdischarge and was clinically stable.
The baby was admitted immediately to the neonatal intensive care unit for incubator care and prophylactic phototherapy. She had exchange blood transfusion done on account of PCV of 25%. She had good recovery and was discharged after 14 days on admission.