Gebretensaye Kesatea Gebrewahd, Jama Abdikani Hassan, Teka Hale, Zelelow Yibrah Berhe, Gebremichael Akebom Kidanemariam
Department of Obstetrics and Gynecology, Daruxannan General Hospital, Burao, Somaliland, Somalia.
Department of Medicine and Health Sciences, Burao University, Burao, Somaliland, Somalia.
Int Med Case Rep J. 2024 Dec 18;17:1049-1054. doi: 10.2147/IMCRJ.S500669. eCollection 2024.
Abdominal pregnancy is a rare but, serious obstetric condition that has continued to pose difficulties in its diagnosis and management. The clinical presentation takes various forms, mostly nonspecific, leading to the delay in diagnosis and management. With a high degree of suspicion, the diagnosis can be made by an abdominal ultrasound particularly in the early trimesters. The objective of this case report is to share our experience in low resource setting dealing with this rare condition diagnosed incidentally during a planned Cesarean section for another obstetric indication.
Twenty-five-year-old primigravida from the Federal Republic of Somalia at a gestational age of 37 + 3 weeks was admitted for elective cesarean section with a diagnosis of Placenta Previa. She had frequent antenatal visits to nearby health facilities with non-specific abdominal symptoms and spotty vaginal bleeding. Intraoperatively, the uterus and right adnexa were normal, while the fetus, chorioamniotic membrane, and placenta were found in the peritoneal cavity and the diagnosis of abdominal pregnancy was made. A 3.5kg live female fetus was delivered with Apgar score of 9 and 10 in the 1 and 5 minutes. Placenta removed through infracolic omentectomy and left adnexectomy. The neonate had facial deformity, bilateral club foot, scoliosis and finger deformities. The mother discharged in good health on the 10 post-operative day and the neonate was linked to orthopedic surgeon for further management.
This case report demonstrates the continuing challenges in early diagnosis and management of this serious obstetric condition. The rarity of the condition in general, and in low resource settings delayed antenatal care (ANC) booking of women, and lack of experience in meticulous ultrasound scanning, are challenges in making an accurate diagnosis. It is recommended that the location of pregnancy should be confirmed in early trimester, vague and nonspecific complaints should be addressed to rule out or rule in ectopic pregnancy.
腹腔妊娠是一种罕见但严重的产科情况，在诊断和管理方面持续存在困难。其临床表现形式多样，大多不具特异性，导致诊断和管理延迟。高度怀疑时，腹部超声可用于诊断，尤其是在孕早期。本病例报告的目的是分享我们在资源匮乏地区处理这一罕见情况的经验，该情况是在因另一产科指征行计划剖宫产时偶然诊断出来的。
一名来自索马里联邦共和国的25岁初产妇，孕37 + 3周，因前置胎盘诊断入院行择期剖宫产。她因非特异性腹部症状和少量阴道出血，频繁到附近医疗机构进行产前检查。术中，子宫和右侧附件正常，而胎儿、绒毛膜羊膜和胎盘位于腹腔内，诊断为腹腔妊娠。娩出一名体重3.5千克的活女婴，1分钟和5分钟Apgar评分分别为9分和10分。通过结肠下网膜切除术和左侧附件切除术取出胎盘。新生儿有面部畸形、双侧马蹄内翻足、脊柱侧弯和手指畸形。母亲术后第10天健康出院，新生儿转诊至整形外科医生处进行进一步治疗。
本病例报告表明，在这种严重产科情况的早期诊断和管理方面仍存在挑战。该情况总体罕见，在资源匮乏地区，女性产前保健（ANC）登记延迟，且缺乏细致超声扫描经验，这些都是准确诊断的挑战。建议在孕早期确认妊娠位置，对模糊和非特异性主诉进行评估，以排除或确诊异位妊娠。
