Diagnostic and management dilemmas in secondary abdominal pregnancy: A
case report and literature review of 314 cases from 1930-2021.
Background- Abdominal pregnancy remains a diagnostic and management
challenge Objective- Highlighting diagnostic and management dilemmas in
secondary abdominal pregnancy Search strategy- MEDLINE, EMBASE, PubMed
and Web of Science searched from 1930-2021. Selection criteria- Articles
on secondary abdominal pregnancies Data collection and analysis- An
illustrative case report of a woman at 13 weeks gestation referred from
a primary health centre with vague abdominal pain. Imaging confirmed
secondary abdominal pregnancy with hemoperitoneum. Emergency laparotomy
revealed significant hemoperitoneum, a live floating fetus in the
abdominal cavity and placental attachment to the left cornu and
fallopian tube which were removed and cornual repair performed. Recovery
was uneventful. We reviewed the literature on secondary abdominal
pregnancies, early and advanced from 1930-2021 and summarised management
and outcomes of 314 such cases. Main Results- Among the 314 cases
reviewed, 295 cases (93.9%) were surgically managed and 19 (6%)
required hysterectomy. Post-surgery methotrexate was given in 9 cases
(2.9%). Following primary methotrexate administration in 18 patients,
10 required surgery (55.5%). Complete placental removal was achieved in
264 cases (84%), partial in 27 (8.6%) and left in situ in 16 (5.1%).
Seventy-four cases (23.6%) required blood transfusion. There were 15
maternal deaths (4.8%). Twenty-seven fetuses (8.6%) were live born, 6
(1.9%) were neonatal deaths and 46 (14.6%) were fetal demise.
Conclusion- Maternal mortality and morbidity is of serious concern in
abdominal pregnancies requiring a high index of suspicion and management
expertise. Funding- None Keywords- abdominal pregnancy, primary
peritoneal pregnancy, secondary abdominal pregnancy, hepatic pregnancy,
omental pregnancy, diaphragmatic pregnancy.